Long-term follow-up results of femoral varus osteotomy in the treatment of Perthes disease, and comparison of open-wedge and closed-wedge osteotomy techniques

Abstract

In this retrospective observational study, I aimed to report long-term follow-up results of femoral varus osteotomy in the treatment of Perthes disease patients who were between 6 and 8 years old at the onset of the disease with Herring B and C hip involvement. I also aimed to compare 2 different osteotomy techniques: open-wedge and closed-wedge femoral varus osteotomies. Patients with Perthes disease treated with femoral varus osteotomies were invited for final examination. Twenty two hips of 19 patients were evaluated. Mean follow-up period was 15.2 years. Patients were divided into 2 homogenous groups according to femoral osteotomy technique. In Group A (12 hips) open-wedge osteotomy, and in Group B (10 hips) closed-wedge osteotomy was performed. There were 15 male (78.9%) and 4 female (21.1%) patients. The median age at the onset of the disease was 7 years in Group A and B. The mean follow-up period was 16.2 years in Group A, and 11.4 years in Group B. According to Stulberg classification 5 hips (22.7%) were healed as Class I, 4 hips (18.2%) were healed as Class II, 12 hips (55.5%) were healed as Class III, and 1 hip (4.6%) was healed as Class IV. Also in Group A 4 hips (33.3%) were healed as Class I or II, 7 hips (58.3%) were healed as Class III, and 1 hip (8.3%) was healed as Class IV; in Group B 5 hips (50.0%) were healed as Class I or II, and 5 hips were healed as Class III (50.0%). There was no significant difference between the groups. According to Iowa scale, mean values were 92.6 in Group A and 92.4 in Group B. There was no significant difference between the groups. At the final follow-up mean center-edge angles of Group A and B were 16 and 22, the difference was significant. Long-term follow-up results showed that femoral varus osteotomy was an effective treatment method in Perthes disease patients who were between 6 and 8 years old with Herring B and C hip involvement at the onset of the disease. Hip joint congruency was obtained with femoral varus osteotomies, and closed-wedge osteotomy served more favorable center-edge angle results.

Combined Femoral Osteotomy and Contralateral Hip Arthroplasty to Correct Limb Alignment and Arthritis in a Scoliosis and Polio Patient: A Case Report

“…In our case, we assessed the parameters and compared them to the normal range reported [ 4 ]. In this case, an open wedge biplane osteotomy was performed at the distal femur, adding a bone graft between the two ends of the wedge incision, thereby preventing shortening [ 5 , 6 ]. Due to the patient’s leg length discrepancy, we chose the open wedge approach, which was ideal for correcting their coronal limb alignment and improving leg length matching [ 7 ].…”

Does Prolonged Weight Relief Increase the Chances of a Favourable Outcome After Containment for Perthes Disease?

“…Nevertheless, there appears to be a trend towards better results in studies that combined containment with prolonged weight relief 3,4,17 than when containment alone was performed. [21][22][23][24][25][26][27][28][29][30] Two reports of children treated in abduction, non-weightbearing braces worn for 18 months show that a high proportion had spherical hips when the disease healed, indicating that nonoperative containment when combined with prolonged weight relief may be equally effective as our approach of surgical containment combined with prolonged weight relief. 3,4…”