Name of the Procedure:

Osteotomy, Intertrochanteric or Subtrochanteric (including internal or external fixation and/or cast)

Summary

An osteotomy in the intertrochanteric or subtrochanteric region involves surgically cutting and realigning the upper part of the femur (thigh bone) near the hip joint. This procedure often involves the use of internal or external fixation devices, or a cast, to stabilize the bone and ensure proper healing.

Purpose

This procedure is designed to correct deformities, relieve pain, or improve function in patients with conditions such as severe arthritis, hip dysplasia, or specific fractures. The main goals are to realign the bone to distribute weight more effectively, alleviate discomfort, and enhance joint mobility.

Indications

• Severe hip arthritis
• Hip dysplasia
• Non-union or malunion of hip fractures
• Congenital deformities of the hip
• Chronic hip pain unresponsive to conservative treatments

Preparation

• Patients may need to fast for 6-12 hours prior to the procedure.
• Adjustments to current medications may be required, especially for blood thinners.
• Pre-operative diagnostic tests such as X-rays, MRI, or CT scans to assess the hip joint.
• Completion of a pre-surgical assessment, including blood tests and a physical examination.

Procedure Description

1. Anesthesia: General or spinal anesthesia is administered.
2. Incision: A surgical incision is made in the region of the hip.
3. Bone Cutting: The surgeon makes precise cuts in the femur to allow for realignment.
4. Realignment: The bone segments are repositioned to correct alignment.
5. Fixation: Internal fixation devices (such as plates, screws, or rods) or external fixators are applied to stabilize the bone. In some cases, a cast may be used.
6. Closure: The incision is closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes around 2 to 3 hours, though this can vary depending on the complexity of the case.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Radiology technician (if intraoperative imaging is needed)
• Physical therapist (for post-operative care)

Risks and Complications

• Infection
• Blood clots
• Nerve or blood vessel damage
• Non-union or delayed healing of the bone
• Dislocation or hardware failure
• Persistent pain or stiffness

Benefits

• Pain relief and improved hip function
• Correction of hip deformities
• Enhanced mobility and quality of life
• Increased longevity of the hip joint

Recovery

• Hospital stay of 2-5 days post-surgery.
• Pain management with medications.
• Limited weight-bearing on the operated leg, usually with crutches or a walker for 6-8 weeks.
• Physical therapy to restore mobility and strength.
• Follow-up appointments for X-rays and surgeon evaluations.
• Full recovery may take 3-6 months, depending on individual healing.

Alternatives

• Hip replacement surgery
• Non-surgical treatments such as physical therapy, medications, and injections
• Pros of alternatives: Less invasive options may have shorter recovery times.
• Cons of alternatives: May not be as effective in severe deformities or advanced arthritis.

Patient Experience

During the procedure, patients are under anesthesia and will not feel pain. Post-surgery, they may experience discomfort, swelling, and temporary immobility. Pain management will be provided, and physical therapy will aid in recovery. Full activity and normal function are typically achieved within 3-6 months.

Pain management and comfort measures post-operatively include prescribed pain relievers and instructions on properly using assistive devices such as crutches.