Joint saving operation procedures in idiopathic femur head necrosis

At first, this report deals with the characteristics of the idiopathic necrosis of the femoral head and the possibilities of operative treatment specially in the sense of saving the hip-joint. Beside old techniques of sanitation of the focus, nowadays the femoral osteotomy, mainly in the sense of a flexion-osteotomy is well to the fore. Hereby, the necrotic area can be turned out of the main loaded part of the hip-joint. We recommend a combination of femoral osteotomy with a ventral capsulotomy and tenotomy. Furthermore, there should be a sanitation of the focus, above all by drilling. Then we report about our experience with this operative treatment. 37 cases out of 52 were controlled clinically and roentgenologically. The subjective results were very good to fair in about 85%, the functional improvement of the hip-joint was mostly good. On the other hand, there was a difference between clinical and roentgenological results, we found an improvement of the necrotic destruction of the femoral head only in 28%. We mainly noticed poor subjective and objective results in cases of too extended necrotic areas, of too advanced stage of necrosis and of secondary coxarthrosis. In those cases we refer to the differential indication of the total hip-arthroplasty.