Femoral neck osteotomy: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Femoral neck osteotomy Introduction (What it is)

Femoral neck osteotomy is a planned surgical cut through the femoral neck, the narrow “bridge” of bone between the femoral head and the femoral shaft.
It is most commonly performed as a step within hip replacement surgery.
It can also be used in selected reconstructive or salvage hip procedures when the femoral head must be removed.
The exact cut location and angle are tailored to the patient’s anatomy and the overall surgical goal.

Why Femoral neck osteotomy used (Purpose / benefits)

The femoral head (the “ball” of the hip) connects to the femoral shaft through the femoral neck. In many hip conditions, the painful or damaged joint surface is on the femoral head and the socket (acetabulum), or the femoral head/neck region is involved in a fracture or collapse. Femoral neck osteotomy allows the surgeon to separate and remove the femoral head (and sometimes part of the neck) so that reconstruction can proceed.

In practical terms, Femoral neck osteotomy is used to:

Enable hip arthroplasty (hip replacement) by removing the femoral head so the surgeon can prepare the femur for an implant and restore hip mechanics.
Address non-reconstructable femoral head/neck problems, such as certain complex fractures, severe collapse of the femoral head, or joint destruction, when joint-preserving options are unlikely to meet the goals of surgery.
Create a controlled, reproducible bone surface for implant positioning, leg-length planning, and soft-tissue balancing (how the muscles and capsule tension the hip).
Improve access and visualization of the hip joint during reconstruction, especially when the joint is stiff or deformed.

Because Femoral neck osteotomy is usually one component of a larger operation, its “benefit” is closely tied to the success of the overall procedure (for example, total hip arthroplasty versus hemiarthroplasty). What the cut accomplishes—and how outcomes are measured—varies by clinician and case.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians may perform Femoral neck osteotomy in scenarios such as:

Total hip arthroplasty for advanced hip osteoarthritis or inflammatory arthritis
Hip arthroplasty for avascular necrosis (osteonecrosis) with femoral head collapse
Hip arthroplasty after failed prior hip surgery (for example, failed fixation or failed resurfacing), depending on anatomy and bone quality
Hemiarthroplasty or total hip arthroplasty for certain femoral neck fractures, especially when replacement is chosen over fixation
Removal of the femoral head/neck as part of a salvage procedure in complex infection or severe joint destruction (approach varies by clinician and case)
Selected tumor or severe bone-destruction cases where resection is required as part of reconstruction planning (specialized decision-making)

Contraindications / when it’s NOT ideal

Because Femoral neck osteotomy is typically part of a broader reconstructive plan, “contraindications” often relate to whether removing the femoral head is appropriate in the first place, or whether a different cut or approach is safer for the anatomy.

Situations where Femoral neck osteotomy may be less suitable, or where another approach may be favored, include:

When the goal is to preserve the native femoral head, such as in some younger patients with certain femoral neck fractures where internal fixation is chosen (decision varies by clinician and case)
Fracture patterns or deformities where a standard neck cut would not provide a stable platform for the intended reconstruction and a different level/geometry of bone cut is needed
Severe bone loss or abnormal anatomy where standard arthroplasty planning is challenging and specialized reconstruction strategies are required
Active infection or uncontrolled systemic illness, where timing and surgical strategy may change; whether bone resection is done, delayed, or combined with staged management varies by clinician and case
Poor tolerance for major surgery or anesthesia, where nonoperative management or less invasive options may be considered depending on goals and overall health

These considerations are highly individualized and depend on the diagnosis, imaging, functional goals, and surgeon experience.

How it works (Mechanism / physiology)

Femoral neck osteotomy works through a straightforward orthopedic principle: a controlled bone cut changes what structures can be removed, repositioned, and reconstructed.

Key anatomy involved

Femoral head: the ball of the ball-and-socket hip joint, covered with cartilage in a healthy hip.
Femoral neck: the narrower segment connecting the head to the femoral shaft; its angle and version (rotation) affect hip mechanics.
Acetabulum (hip socket): part of the pelvis that articulates with the femoral head.
Hip capsule and surrounding muscles: soft tissues that stabilize the joint; their tension affects hip stability after reconstruction.

Biomechanical rationale (high level)

In hip replacement surgery, removing the femoral head and making a precise neck cut helps the surgeon:

Set the “starting geometry” for preparing the femur (for example, broaching or reaming) for an implant.
Manage leg length and offset (offset is the lateral distance that affects hip muscle leverage), by selecting the cut height and implant configuration.
Facilitate stable joint reconstruction, since implant position, soft-tissue tension, and bone quality interact to influence dislocation risk, gait mechanics, and comfort.

Onset, duration, and reversibility

Femoral neck osteotomy is not a medication or device with an onset/duration profile. It is a permanent surgical change to bone anatomy. Any functional “effect” depends on the subsequent reconstruction (such as the implant type and placement, and rehabilitation progression).

Femoral neck osteotomy Procedure overview (How it’s applied)

Femoral neck osteotomy is generally performed as a step inside a larger hip operation rather than as a stand-alone procedure. A simplified workflow often looks like this:

Evaluation / exam – History, physical exam, and review of symptoms and functional limits – Imaging (commonly X-rays; other imaging may be used depending on the diagnosis) – Surgical planning or templating to estimate cut level, implant sizing, and alignment goals (varies by clinician and case)
Preparation – Anesthesia planning and positioning on the operating table – Selection of surgical approach to the hip (approach choice varies by clinician and case) – Exposure of the hip joint while protecting nearby soft tissues
Intervention (the osteotomy step) – The surgeon identifies landmarks on the femur and plans the cut level and angle – A controlled cut is made through the femoral neck to separate the femoral head from the shaft – The femoral head is removed to allow access for reconstruction (such as preparing the femur and/or acetabulum)
Immediate checks – Trial components (in arthroplasty cases) may be used to assess hip stability, leg length, and range of motion – Imaging may be used intraoperatively in some settings, depending on approach and equipment
Follow-up – Postoperative monitoring, wound checks, and rehabilitation planning – Weight-bearing status and activity progression depend on the overall operation, fixation method, bone quality, and surgeon preference

Specific tools, measurements, and decision points differ across surgical techniques and implant systems.

Types / variations

“Femoral neck osteotomy” can refer to different cut patterns and contexts. Common variations include:

By surgical context
Total hip arthroplasty (THA): the neck cut is made so the femoral head can be removed and replaced with a stem and head component.
Hemiarthroplasty: the femoral head is replaced while the acetabulum is typically not resurfaced.
Revision hip arthroplasty: the osteotomy may be influenced by existing implants, cement, or altered anatomy; complexity varies by case.
Salvage/resection procedures: in selected cases, the femoral head/neck is removed as part of infection or severe joint destruction management (strategies vary by clinician and case).
By level of cut
More “head-near” (subcapital) cuts versus more “base-of-neck” (basicervical) cuts, described in relation to the femoral head and the intertrochanteric region. The chosen level depends on anatomy, fracture pattern (if present), and reconstruction plan.
By cut orientation and planning goals
Adjustments to the angle and height of the cut can influence leg length, offset, and implant seating in arthroplasty.
Some surgeons use specific measuring methods (for example, referencing the lesser trochanter) to help reproduce planned geometry; methods vary by clinician and case.
By surgical approach and exposure
The osteotomy is performed through the approach used to access the hip (posterior, anterolateral, direct anterior, or others). The approach can influence visualization, soft-tissue handling, and workflow, but the core idea of the neck cut is consistent.

Pros and cons

Pros:

Creates a controlled way to remove the femoral head when hip reconstruction is needed
Helps enable implant placement and hip joint reconstruction in arthroplasty settings
Supports planning for leg length and hip offset as part of overall surgical strategy
Can improve access to the acetabulum and proximal femur during reconstruction
Allows damaged joint surfaces to be removed when joint preservation is not the goal

Cons:

It is an irreversible bone cut and typically commits the operation to a reconstructive pathway
Outcomes depend on the larger procedure (implant choice, alignment, fixation, soft-tissue balance), not the cut alone
Like any bone cut, it introduces risks such as bleeding, fracture, or injury to nearby tissues (risk profile varies by clinician and case)
Inadequate or poorly matched cut geometry can complicate reconstruction steps (managed through planning and technique)
Not appropriate when preserving the native femoral head is the preferred strategy for the condition

Aftercare & longevity

Aftercare and “how long it lasts” are best understood in relation to the overall surgery that includes Femoral neck osteotomy, most often hip arthroplasty.

Factors that commonly influence recovery experience and longer-term durability include:

Underlying diagnosis and severity
Advanced arthritis, fracture complexity, osteonecrosis, deformity, or prior surgery can change rehabilitation demands and expected milestones.
Bone quality and healing environment
Bone density, nutrition status, smoking status, and certain medical conditions can influence healing and complication risk. The relevance of each factor varies by clinician and case.
Implant design and fixation method (when arthroplasty is performed)
Cemented versus uncemented fixation, bearing surfaces, and stem geometry can affect early stability and long-term performance. Longevity varies by material and manufacturer.
Soft-tissue condition and hip stability
Muscle strength, tendon integrity, and capsular repair (when performed) influence stability and gait mechanics after surgery.
Rehabilitation participation and activity exposure
Physical therapy focus, adherence, and return-to-activity demands affect function. Activity recommendations vary by clinician and case.
Follow-up schedule and monitoring
Follow-up visits help evaluate healing, implant position (when present), and functional progress, and can identify complications earlier.

Because Femoral neck osteotomy is not typically performed alone, it does not have a single “longevity” profile separate from the reconstructive procedure it supports.

Alternatives / comparisons

Alternatives depend on why Femoral neck osteotomy is being considered—most often, whether the condition can be managed without removing the femoral head.

Common comparisons include:

Observation / monitoring
For mild symptoms or early disease, clinicians may monitor progression with periodic exams and imaging. This avoids surgical risks but may not address structural joint damage.
Medication and activity modification
Pain-relieving medications and load-management strategies may help symptoms in arthritis or overuse-related pain. They do not reverse advanced cartilage loss or correct unstable fractures.
Physical therapy
Rehabilitation can improve strength, mobility, and gait mechanics, and may reduce pain for some hip conditions. It cannot “rebuild” a collapsed femoral head or mechanically stabilize an unstable fracture, but it can be an important component of nonoperative care or postoperative recovery.
Injections
Intra-articular injections may offer temporary symptom relief in selected hip conditions. Response and duration vary by medication type and patient factors.
Hip-preserving surgery (selected cases)
Procedures aimed at preserving the natural joint (for example, certain corrective osteotomies or other reconstructive techniques) may be considered for specific diagnoses and patient profiles. Whether these are appropriate varies widely by clinician and case.
Internal fixation (for some femoral neck fractures)
In certain patients—often younger or with specific fracture patterns—surgeons may try to stabilize the fracture with screws or other fixation rather than replacing the joint. This keeps the native femoral head but carries its own risks, including nonunion (failure to heal) or osteonecrosis.
Hip arthroplasty approaches without emphasizing the “neck osteotomy” step
Even when arthroplasty is chosen, surgeons may differ in approach, implant system, and technique. The femoral neck cut remains a common component, but how it is executed and what it prioritizes can differ.

Femoral neck osteotomy Common questions (FAQ)

Q: Is Femoral neck osteotomy the same as a total hip replacement?
Femoral neck osteotomy is usually a step within a total hip replacement, not the entire operation. Total hip replacement also includes preparing the femur and acetabulum and implanting components to recreate the joint. In some cases it is also part of hemiarthroplasty or revision surgery.

Q: Why do surgeons cut the femoral neck during hip replacement?
The cut allows the femoral head to be removed so the surgeon can access the hip joint and reconstruct it. It also helps establish a planned geometry that supports implant positioning and soft-tissue balancing. The exact plan varies by clinician and case.

Q: Will this procedure change my leg length?
Leg-length perception after hip reconstruction is influenced by many factors, including implant selection, hip stability, pelvic tilt, and muscle tightness. The neck cut is one element in that planning, but it is not the only factor. Clinicians commonly assess leg length during surgery using their preferred methods.

Q: How painful is recovery after a surgery that includes Femoral neck osteotomy?
Pain experiences vary significantly by procedure type, surgical approach, and individual factors. Postoperative pain control typically uses a combination of strategies, which may include regional anesthesia and medications. Most recovery discomfort is related to the overall operation and soft-tissue healing rather than the bone cut alone.

Q: How long does it take to recover?
Recovery timelines depend on the underlying diagnosis (arthritis versus fracture), the exact operation (THA versus hemiarthroplasty versus revision), and rehabilitation progression. Many people improve gradually over weeks to months, but the pace is individualized. Your clinician’s expected milestones may differ from someone else’s.

Q: Will I be able to put weight on the leg right away?
Weight-bearing status is determined by the overall reconstruction, implant fixation method, bone quality, and intraoperative findings. Some patients are allowed early weight bearing, while others have restrictions. This varies by clinician and case.

Q: Is Femoral neck osteotomy reversible?
No. An osteotomy removes bone continuity at the cut, and in arthroplasty settings the femoral head is removed. Future surgeries can revise or change implants if needed, but the original femoral head is not restored.

Q: What are the main risks associated with Femoral neck osteotomy?
Risks relate to the broader surgery and can include bleeding, infection, fracture, blood clots, nerve or vessel injury, instability/dislocation (in arthroplasty), and differences in leg length perception. The likelihood of specific risks varies by clinician and case. Surgeons use planning, technique, and postoperative protocols to reduce risk.

Q: How much does surgery involving Femoral neck osteotomy cost?
Costs vary widely by country, hospital setting, insurance coverage, implant selection, and whether the surgery is primary or revision. Surgeon fees, facility fees, anesthesia, imaging, and rehabilitation can all contribute. A precise estimate typically requires a case-specific billing review.

Q: When can someone drive or return to work after surgery that includes Femoral neck osteotomy?
This depends on pain control, mobility, reaction time, side of surgery, job demands, and clinician clearance. Desk-based work may resume earlier than physically demanding work, but timelines differ significantly. Clinicians typically base guidance on functional readiness and safety considerations rather than a single fixed timeline.