Medial opening wedge valgus intertrochanteric osteotomy for femoral neck nonunion: a femoral anatomy-preserving surgical approach.

Background: Valgus osteotomy is a femoral head-preserving surgery to treat femoral neck non-union in young, active patients. The traditional approach, however, causes medialisation of the femoral shaft during valgus correction, which alters femoral anatomy and complicates conversion to total hip arthroplasty if head osteosynthesis fails. This study aims to outline a novel surgical technique, medial opening wedge valgus intertrochanteric osteotomy (VITO), and evaluate its clinical and radiographic outcomes, focusing on restoring hip biomechanics and improving union rates.

Methods: Between 2007 and 2022, this technique was used in 18 cases (mean age 39; range 16-51 years). There were 14 males and 4 females. Non-union was due to failed internal fixation in 10 cases, while in 8 cases was due to neglected fractures. Treatment outcomes were evaluated by assessing union, pre- and postoperative neck-shaft angle (NSA) correction and functional outcomes by the Harris Hip Score (HHS).

Results: 16 out of 18 patients were available for follow-up. The average duration of nonunion was 10.7 (range 1-60) months and the mean follow-up was 64 (range 24-140) months. All achieved successful union, with an average neck shaft angle correction of 16°. 3 patients were converted to total hip arthroplasty (THA) due to implant failure. Complications included 3 cases of avascular necrosis (AVN). Despite these complications, 62% of patients had excellent HHS, and 19% had good HHS. The mean improvement in HHS was 92 (postoperative) from 46 (preoperative).

Conclusions: The medial opening wedge VITO is an effective technique for restoring hip biomechanics and achieving high union rates in patients with femoral neck non-union. This technique preserves the proximal femoral anatomy, facilitating easier conversion to THA when necessary.