Due to advances in total joint replacement, intertrochanteric osteotomy (ITO) is performed more infrequently in spite of good clinical results. Nevertheless, there are several good indications for this joint-preserving procedure in adults. Detailed biomechanical knowledge and precise clinical examination are prerequisites for correct indications and planning of ITO. The main target of this surgical procedure is improvement of joint congruency and normalization of load transfer to protect damaged cartilage. Very good results can be obtained in hip dysplasia, non-union of the femoral neck and proximal femoral deformities if the therapeutic principles are followed. Higher failure rates have to be expected in femoral head necrosis and osteoarthritis, depending on the degree of pre-existing cartilage damage.
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