Clinical Context
A typical patient is an active adolescent or young adult presenting with symptomatic femoroacetabular impingement, slipped capital femoral epiphysis sequelae, developmental coxa vara, or malunited proximal femoral fracture resulting in abnormal femoral neck-shaft alignment and hip pain or restricted range of motion. The patient has persistent groin or lateral hip pain, pain with pivoting or internal rotation, reduced hip flexion, and radiographic evidence of femoral neck deformity (e.g., coxa vara, excessive femoral anteversion/retroversion, cam lesion deformity). Conservative measures (activity modification, physical therapy, NSAIDs, and targeted injections) have failed or are insufficient.
Preoperative workflow includes history and physical examination, standing and frog-leg lateral radiographs, CT or MRI for 3D deformity assessment and planning, templating osteotomy correction (wedge size and orientation), medical clearance, and patient counseling regarding risks and expected recovery. Intraoperatively, the orthopedic surgeon performs a femoral neck osteotomy — removing a wedge-shaped portion of the femoral neck to correct alignment — often with internal fixation (e.g., plates, screws, pediatric/pelvic fixation devices) and possible concomitant hip arthroscopy or acetabular procedures. Postoperative care includes pain control, DVT prophylaxis, weight-bearing restrictions, serial radiographs to confirm union, and outpatient physical therapy until functional recovery.
Typical site of service: Hospital inpatient, Hospital outpatient (ambulatory surgery center when appropriate), or Ambulatory Surgery Center depending on patient comorbidity and concurrent procedures.
Typical providers involved: orthopedic surgeon specializing in adult reconstruction or pediatric orthopedics, anesthesiologist, perioperative nursing, radiology for intraoperative imaging, and physical therapy for rehabilitation.