Proximal femoral focal deficiency. Results of conservative and surgical treatment, critical analysis and indications

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The treatment of proximal focal femoral deficiency (PFFD) has always been a challenge for the pediatric orthopaedic surgeon. Multiple conservative and surgical approaches have been recommended with frequently unsatisfactory results. We reviewed the medical records of 22 patients seen between 1981 and 1990, and evaluated the results and complications of 3 different treatments administered according to the extent of leg length discrepancy. Of the 22 patients, 5 with the greatest leg length discrepancy were treated with hip stabilization (group A), 14 patients had leg lengthening (group B) and 3 patients had conservative treatment and orthosis (group C). The average follow-up period was16.8 years (range, 10–22 years). Mean age of the patients at treatment was 5.8 years (range, 1–12 years) in group A, 8.4 years (range, 4–16 years) in group B and 3.3 years (range, 1-6 years) in group C. Roentgenograms showed stable hips (Fixsen and Lloyd-Robert's type I) in only 2 of 5 patients from group A and 7 of 14 patients of group B. The remaining were unstable hips (Fixsen and Lloyd-Robert's types II and III). In group B the Wagner apparatus was used in 12 cases, Orthofix in 1 case and Lazo-Canadell in 1 case. 6 patients in group B underwent more that one lengthening. The mean residual shortenings in groups A, B and C were, respectively, 12.2 cm (range, 2–27), 11.5 cm (range, 1–20) and 18.1 cm (range, 4–27). The patients were evaluated in reference to gait, range of motion at knee and hip levels, stability of the hip and knee and residual shortening on an original scoring scale. Group A showed 60.0% of good results (3 of 5 cases), group B 64.3% (9 of 14 cases) and group C 66.6% (2 of 3 cases). Among patients who sustained to femoral lengthening (group B), complications were osteitis (6 cases), angular deformity (3 cases), pseudoarthrosis (1 case), and fracture (1 case); group A presented 2 cases of pseudoarthrosis while group C had no complications. This experience confirms that the treatment of the patient must be individualized with reference to age, presence or absence of stable hip and other anomalies of the limb. The contribution we make for further evaluations is a proposed new scoring system.