Morscher’s femoral neck lengthening osteotomy through surgical hip dislocation approach for preservation of Perthes and Perthes-like deformities

Abstract

Background: Typical sequelae of Perthes disease and Perthes-like deformities comprise a short femoral neck, aspherical femoral head, and greater trochanteric overgrowth. Morscher’s osteotomy aims at restoring the normal extra-articular anatomy, but incapable of restoring a normal head-neck contour with residual impingement. Femoral neck lengthening osteotomy combined with osteochondroplasty through surgical hip dislocation approach was not previously described in the literature. We hypothesized that this technique is capable of near-normal restoration of the proximal femoral anatomy, increasing limb length, restoring abductor power, and simultaneous management of intra-articular chondro-labral disease. Methods: A prospective series of 21 consecutive patients with sequelae of Perthes disease and Perthes-like deformity (Stulberg II and III) were treated by Morscher’s osteotomy through surgical hip dislocation approach. The mean age was 14.9 years (9–30 years) and the mean follow-up was 4.5 years (2–8 years). Results: The mean Harris hip score improved significantly from 66.5 to 89.5 points (p < 0.001), and the mean limb length discrepancy improved from 2.5 to 0.6 cm (p < 0.001). The mean alpha angle improved from 81.8° to 49.5°, the mean neck-shaft angle increased from 117.8° to 129.8°, and the articulo-trochanteric distance has improved from −6.7 to 20.8 mm. Six out of 21 patients required staged periacetabular osteotomy for residual acetabular dysplasia. No cases of chondrolysis or osteonecrosis were identified. Conclusion: Femoral neck lengthening osteotomy through surgical hip dislocation appraoch has proven to be safe and effective for preservation of symptomatic hips with Perthes and Perthes-like deformities and mild to moderate femoral head deformities (Stulberg II and III). A staged periacetabular osteotomy may be required in those patients with significant acetabular dysplasia. Level of evidence: Level IV.

Osteochondritis Dissecans of the Hip in Legg-Calvé-Perthes Disease: Case Report and Review

“… 9 , 14 These lesions often remain asymptomatic and require nonoperative treatment, unless the fragment is loose, causing locking, catching, pain, limping and limited range of motion. 6 , 8 – 10 The symptoms were observed in our patient four years after the onset of LCPD. For these symptomatic patients, there are basically four treatment options: OCD fragment fixation, osteochondral autograft transfer (OAT), fresh osteochondral allograft and OCD fragment arthroscopic resection.…”

“… 1 – 4 , 6 , 7 , 9 Age at disease onset and diagnosis, sex, range of motion of the hip and severity of the disease / necrosis are considered potential prognostic factors in LCPD. Despite early treatment efforts, many patients evolve with residual femoral head deformity that may be symptomatic with a residual limp and decreased hip motion 1 – 3 , 10 , 12 , 13 …”

“… 2 , 8 , 12 The prognosis of the hip joint affected by LCPD depends on the age of the patient at the time of onset, patient weight, the stage of the disease, the extent of epiphyseal involvement, height of the lateral pillar and the extrusion of the femoral head. 5 , 8 , 10 , 13 …”

The McMaster osteotomy—a novel surgical treatment to chronic slipped capital femoral epiphysis: description of surgical technique and case study

“…The Morscher osteotomy is a true neck-lengthening osteotomy used to treat hip deformities secondary to Legg–Calve–Perthes disease (LCPD) or developmental dysplasia of the hip (DDH) [ 19 , 20 ]. This technique increases femoral offset and distalizes the overriding GT, thus improving abductor mechanics and reducing extracapsular impingement [ 21 ].…”

A Femoral Neck Osteotomy for the Patients with Ankylosing Spondylitis and Thoracolumbar Kyphosis Combined with Hip Flexion Contracture

“…Femoral neck rotational osteotomy is reported to be a modified method for treating necrotic femoral heads 6 . The femoral neck lengthening osteotomy is suggested to preserve hips with Perthes and Perthes‐like deformities 7 . But they all use internal fixation to keep the osteotomy stable.…”