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Pistol grip deformity of the femoral head-neck junction and slipped capital femoral epiphysis can cause anterior impingement leading to pain, cartilage damage and eventual osteoarthritis.1-3 Osteoplasty of this metaphyseal prominence, with or without concomitant intertrochanteric osteotomy, using a surgical dislocation approach, can effectively treat this problem.4,5Clinical and radiographic outcomes were assessed in 19 patients who underwent osteoplasty or osteoplasty/intertrochanteric osteotomy via Ganz-type surgical dislocation with average 12-month follow-up. Preoperative and postoperative Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaires and radiographs were obtained and evaluated.6 In the osteoplasty group, 7 patients improved, 4 were unchanged, and 2 worsened. In the osteoplasty/osteotomy group, 5 of 6 patients improved. Patients with chondral flaps had less improvement. No avascular necrosis was noted postoperatively, and all trochanteric osteotomies healed. The surgical dislocation approach, combined with osteoplasty and/or bony realignment, is a safe efficacious treatment option for symptomatic pistol grip deformity. Outcomes are worse if there is preexisting cartilage damage.