Early innominate osteotomy as a treatment for avascular necrosis complicating developmental hip dysplasia

The clinical and radiographic outcomes of 25 patients with avascular necrosis (AVN) of the femoral head complicating developmental hip dysplasia (DDH) were analyzed. Seven patients (group A) had an innominate osteotomy 1-3 years after the ischemic insult. Eight patients (group B) had a pelvic osteotomy between 5 and 10 years after the insult, and 10 patients (group C) did not have a pelvic osteotomy. The minimum follow-up period was 10 years from the time of the ischemic insult. The hips in group A patients (early osteotomy) showed significantly better radiographic outcomes as assessed by a modified Severin grading. These patients also had less pain, fewer gait disturbances, and required fewer additional procedures for limb length discrepancy or greater trochanteric overgrowth.