Periosteal Stripping and Periosteal Division for Leg Length Discrepancy After Proximal Femoral Intertrochanteric Osteotomy for Perthes Disease.

Abstract

Background and objective Periosteal stripping and periosteal division (PSPD) can help promotethe growth of the long bone in children with leg length discrepancy (LLD). We performed PSPD in a cohort of patients when LLD was observed at the time of implant removal surgery after proximal femoral osteotomy for Perthes disease. This study aimed to clarify the efficacy and safety of PSPD for acquired LLD related to Perthes disease. Methods This retrospective study enrolled 10 patients treated with PSPD and six controls who declinedPSPD for LLD associated with Perthes disease. The lengths of the femur, tibia, and entire leg were measured in the full-length standing radiographs at baseline and final follow-up. The baseline was defined as the time of the last preoperative observation. LLD and changes in LLD (ΔLLD) were measured. The correlation of ΔLLD with age at the time of surgery, follow-up period, and extent of PSPD was investigated. Results In the PSPD group, the mean age of the patients was9.4 years and the mean LLD at baseline was 20.5 ± 4.6 mm, while it was 10.2 years and 11.5 ± 10.0 mm in the control group. With a mean follow-up period of 4.3 years, the PSPD group showed a mean ΔLLD decrease of 13.9 mm, which was significantly greater than that of the control group at 3.2 mm with a mean follow-up period of 5.4 years. Logistic regression analysis revealed that age at the time of surgery was a significant factor for obtaining >10 mm ΔLLD with PSPD and the cutoff value by the receiver operating characteristic curve was 9.6 years (sensitivity: 0.83; specificity: 0.83). Conclusions PSPD seems to be a safe and effective surgical option for LLD associated with Perthes disease. The age at the time of surgery negatively correlated with the amount of LLD correction. Obtaining >10 mm LLD correction is more likely if the patients are <10 years of age.