title: Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children.
abstract: OBJECTIVE
  Total necrosis of the femoral head after infection in children during their first months of life gives a dislocated hip with severe leg shortening. A new femoral head can be achieved with subtrochanteric osteotomy and transposition of the apophysis of the greater trochanter into the acetabulum. Previous reports have dealt with short-term results (up to 12 years). Here I present some results of this procedure 15-24 years after operation.
  
  
  METHODS
  4 children aged 1-6 years with complete necrosis of the femoral head were operated on with transposition of the greater trochanter. Secondary shelf plasty was performed later in 1 child, distal femoral epiphysiodesis in another, and femoral bone lengthening in 1 child. The mean follow-up period was 19 (15-24) years.
  
  
  RESULTS
  A new femoral head developed in all hips. 2 of them had a spherical head with a good acetabular cover, and without any osteoarthritis except for slight reduction of cartilage height. These hips were painless, with a mobility that allowed good walking function after 16 and 24 years, respectively. In the other 2 patients, in which there was a severe acetabular dysplasia at the primary operation, the new femoral head was somewhat flattened; painful osteoarthritis led to hip replacement 15 and 21 years after trochanter arthroplasty. Even these patients had a relatively good walking function until the last couple of years before hip replacement. Maximum leg length discrepancy was 7 cm.
  
  
  CONCLUSIONS
  Trochanter arthroplasty with subtrochanteric osteotomy in total femoral head necrosis after septic arthritis in children may give satisfactory long-term results provided adequate acetabular cover is obtained. Although the method cannot provide a normal hip, it can contribute to less length discrepancy, less pain, improved gait, and more favorable conditions for later hip replacement.
authors.affiliation: Department of Orthpaedics, St. Olav's University Hospital, Norwegian University of Science and Technology, Trondheim, Norway. pal.benum@ntnu.no
authors.forename: Pål
authors.initials: P
authors.lastname: Benum
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001170:Arthritis, Infectious / Q000150:complications*; D001178:Arthroplasty / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000209:etiology / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D015207:Osteoarthritis, Hip / Q000150:complications*; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult