Perthes disease: comparison of two surgical options.

Abstract

Varus intertrochanteric osteotomy (ITO) remains the most popular method to contain the fragmenting femoral head in Perthes disease. However, resultant compromise of hip abductors may result in coxa brevis and acetabular dysplasia, increasing the risk of requiring future surgery. A minimally invasive strategy of tension plating the greater trochanter was developed in effort to avoid these consequences. The objective is to compare greater trochanter-guided growth to ITO for treatment of Perthes disease. This IRB approved, retrospective review compares two series of children with Perthes, one treated with ITO and one with greater trochanter-guided growth (GG). Clinical examination findings and clinical course were recorded via chart review. Weight-bearing pelvic X-rays were analyzed preoperatively and at the last known follow-up prior to other procedures. There were 58 patients: 18 underwent ITO versus 40 GG. The groups matched in age, sex, examination, and radiographic parameters. Average follow-up was 5 years. The change in the center head-trochanteric distance (CTD) was statistically significant ( P < 0.05), -0.3 cm in GG versus -1.09 cm in ITO patients. At final follow-up, the ITO group was more likely to have LLD ≥ 2 cm (16.67% vs. 0%; P = 0.03) and 52.5% of GG patients were classified as Stulberg III or greater, versus 72.2% of the ITO group ( P < 0.001). Ninety-four percent of ITO patients versus 40% of GG required additional surgery. Containment by ITO reflects exclusive focus upon the femoral head, without considering long-term sequelae. GG addresses the femoral neck issues potentially providing better outcomes. Level of Evidence. This is a level III study providing further understanding of the properties of the proximal femoral physes and an alternative for surgical management of perthes disease.