Femoral Head Reduction Osteotomy for the Treatment of Severe Femoral Head Deformities and Articular Incongruity in Children with Perthes Disease
- Authors: Bortulev P.I.1, Baskaeva T.V.1, Poznovich M.S.1, Barsukov D.B.1, Pozdnikin I.Y.1, Rustamov A.N.1
-
Affiliations:
- H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
- Issue: Vol 31, No 1 (2025)
- Pages: 20-33
- Section: Clinical studies
- URL: https://journal-vniispk.ru/2311-2905/article/view/287975
- DOI: https://doi.org/10.17816/2311-2905-17645
- ID: 287975
Cite item
Abstract
Background. Lack of adequate treatment for children with Perthes disease leads to the formation of severe femoral head deformity with articular surfaces incongruity, followed by the development of femoroacetabular impingement and early hip osteoarthritis. To date, femoral head reduction osteotomy is the most effective treatment option for such patients. However, the results of its performance have been discussed in only a few case-control studies with small sample sizes in both international and domestic literature.
The aim of the study was to evaluate the effectiveness and safety of femoral head reduction osteotomy and to analyze the further development of the hip joint in children operated for severe femoral head deformity due to Perthes disease.
Methods. We have analyzed preoperative and postoperative results of clinical and radiological examination of 20 patients (20 hip joints) aged 8 to 12 years with deformed Perthes femoral head and articular surfaces incongruity. Femoral head reduction osteotomy was performed in all patients.
Results. A radical proximal femoral reconstruction has led to significant improvement in the shape of the proximal femur with improved head sphericity and restoration of articular congruence. However, at the 6- to 12-month follow-up, some patients, primarily those with progressive lateral acetabular rim deformity, exhibited a decrease in the intraoperatively achieved Wiberg angle, an increase in the percentage of femoral head extrusion from the acetabulum, and varying degrees of Shenton line disruption.
Conclusions. Performing femoral head reduction osteotomy with correct surgical technique is an effective reconstructive technique for the treatment of children with a severe saddle-shaped deformity of the femoral head and articular surfaces incongruity. In patients with Tönnis and Sharp angles exceeding the upper limit of the physiological norm, due to the formation of secondary subluxation, it is advisable to simultaneously perform femoral head reduction osteotomy and triple/periacetabular pelvic osteotomy. This treatment option should be chosen only after a critical analysis of potential risks.
Full Text
##article.viewOnOriginalSite##About the authors
Pavel I. Bortulev
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Author for correspondence.
Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
Cand. Sci. (Med.)
Russian Federation, St. PetersburgTamila V. Baskaeva
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
Russian Federation, St. Petersburg
Makhmud S. Poznovich
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: poznovich@bk.ru
ORCID iD: 0000-0003-2534-9252
Russian Federation, St. Petersburg
Dmitry B. Barsukov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
Cand. Sci. (Med.)
Russian Federation, St. PetersburgIvan Yu. Pozdnikin
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
Cand. Sci. (Med.)
Russian Federation, St. PetersburgArslan N. Rustamov
H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
Email: arslan.rustamov1999@mail.ru
ORCID iD: 0009-0001-6710-0327
Russian Federation, St. Petersburg
References
- Pavone V., Chisari E., Vescio A., Lizzio C., Sessa G., Testa G. Aetiology of Legg-Calvé-Perthes disease: A systematic review. World J Orthop. 2019;10(3): 145-165. doi: 10.5312/wjo.v10.i3.145.
- Панин М.А., Загородний Н.В., Самоходская Л.М., Бойко А.В. Значение полиморфизмов гена метилентетрагидрофолатредуктазы (MTHFR) в патогенезе нетравматического асептического некроза головки бедренной кости. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2020;27(2):19-23. doi: 10.17816/vto202027219-23. Panin M.A., Zagorodniy N.V., Samohodskaya L.M., Boiko A.V. The value of the MTHFR polymorphisms in pathogenesis of nontraumatic necrosis of femoral head. N.N. Priorov Journal of Traumatology and Orthopedics. 2020;27(2):19-23. (In Russian). doi: 10.17816/vto202027219-23.
- Dimeglio A., Canavese F. Imaging in Legg-Calvé-Perthes disease. Orthop Clin North Am. 2011;42(3):297-302. doi: 10.1016/j.ocl.2011.04.003.
- Gao H., Huang Z., Jia Z., Ye H., Fu F., Song M. et al. Influence of passive smoking on the onset of Legg-Calvè-Perthes disease: a systematic review and meta-analysis. J Pediatr Orthop B. 2020;29(6):556-566. doi: 10.1097/BPB.0000000000000725.
- Chen G., Chen T., Zhang P., Zhang Z., Huang R., Chen T. et al. Can large doses of glucocorticoids lead to Perthes? A case report and review of the literature. BMC Pediatr. 2021;21(1):339. doi: 10.1186/s12887-021-02755-4.
- Rodríguez-Olivas A.O., Hernández-Zamora E., Reyes-Maldonado E. Legg-Calvé-Perthes disease overview. Orphanet J Rare Dis. 2022;17(1):125. doi: 10.1186/s13023-022-02275-z.
- Perry D.C., Arch B., Appelbe D., Francis P., Craven J., Monsell F.P. et al. The British Orthopaedic Surgery Surveillance study: Perthes’ disease: the epidemiology and two-year outcomes from a prospective cohort in Great Britain. Bone Joint J. 2022;104-B(4):510-518. doi: 10.1302/0301-620X.104B4.BJJ-2021-1708.R1.
- Wadström M.G., Hailer N.P., Hailer Y.D. Demographics and risk for containment surgery in patients with unilateral Legg-Calvé-Perthes disease: a national population-based cohort study of 309 patients from the Swedish Pediatric Orthopedic Quality Register. Acta Orthop. 2024;95:333-339. doi: 10.2340/17453674.2024.40907.
- Perry D.C., Skellorn P.J., Bruce C.E. The lognormal age of onset distribution in Perthes’ disease: an analysis from a large well-defined cohort. Bone Joint J. 2016; 98-B(5):710-714. doi: 10.1302/0301-620X.98B5.36453.
- Maleki A., Qoreishy S.M., Bahrami M.N. Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review. Interact J Med Res. 2021;10(2):e27075. doi: 10.2196/27075.
- Hong P., Zhao X., Liu R., Rai S., Song Y., Xu R. Perthes Disease in a Child With Osteogenesis Imperfecta From a Rare Genetic Variant: A Case Report. Front Genet. 2022;13:920950. doi: 10.3389/fgene.2022.920950.
- Wenger D.R., Pandya N.K. Advanced containment methods for the treatment of Perthes disease: Salter plus varus osteotomy and triple pelvic osteotomy. J Pediatr Orthop. 2011;31(2 Suppl):S198-205. doi: 10.1097/BPO.0b013e31822602b0.
- Joseph B., Price C.T. Principles of containment treatment aimed at preventing femoral head deformation in Perthes disease. Orthop Clin North Am. 2011; 42(3):317-327. doi: 10.1016/j.ocl.2011.04.001.
- Nelitz M., Lippacher S., Krauspe R., Reichel H. Perthes disease: current principles of diagnosis and treatment. Dtsch Arztebl Int. 2009;106(31-32):517-523. doi: 10.3238/arztebl.2009.0517.
- Camurcu I.Y., Yildirim T., Buyuk A.F., Gursu S.S., Bursali A., Sahin V. Tönnis triple pelvic osteotomy for Legg-Calve-Perthes disease. Int Orthop. 2015;39(3): 485-490. doi: 10.1007/s00264-014-2585-6.
- Rosello O., Solla F., Oborocianu I., Chau E., ElHayek T., Clement J.L. et al. Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy. Hip Int. 2018;28(3):297-301. doi: 10.5301/hipint.5000569.
- Барсуков Д.Б., Краснов А.И., Басков В.Е., Поздникин И.Ю., Волошин С.Ю., Баскаева Т.В. и др. Корригирующая остеотомия бедра в комплексном лечении детей с болезнью Легга-Кальве-Пертеса. Гений ортопедии. 2017;23(1):63-70. doi: 10.18019/1028-4427-2017-23-1-63-70. Barsukov D.B., Krasnov A.I., Baskov V.E., Pozdnikin I.Yu., Voloshin S.Yu., Baskaeva T.V. et al. Corrective femoral osteotomy in the complex treatment of children with Legg-Calve-Perthes disease. Genij Ortopedii. 2017;23(1):63-70. (In Russian). doi: 10.18019/1028-4427-2017-23-1-63-70.
- Singh K.A., Guddattu V., Shah H. Radiologic Outcomes of Bilateral and Unilateral Perthes Disease: A Comparative Cohort Study. J Pediatr Orthop. 2022;42(2):e168-e173. doi: 10.1097/BPO.0000000000002010.
- Abril J.C., Montero M., Fraga M., Egea-Gámez R.M. Ellipsoidal Process of the Femoral Head in Legg-Calvé-Perthes Disease: Effect of Prophylactic Hemiepiphysiodesis. Indian J Orthop. 2022;56(8): 1431-1438. doi: 10.1007/s43465-022-00662-z.
- Louahem M’sabah D., Assi C., Cottalorda J. Proximal femoral osteotomies in children. Orthop Traumatol Surg Res. 2013;99(1 Suppl):S171-186. doi: 10.1016/j.otsr.2012.11.003.
- Clohisy J.C., Nepple J.J., Ross J.R., Pashos G., Schoenecker P.L. Does surgical hip dislocation and periacetabular osteotomy improve pain in patients with Perthes-like deformities and acetabular dysplasia? Clin Orthop Relat Res. 2015;473(4):1370-1377. doi: 10.1007/s11999-014-4115-7.
- Leunig M., Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1: S62-67.
- Siebenrock K.A., Anwander H., Zurmühle C.A., Tannast M., Slongo T., Steppacher S.D. Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 2015;473(4):1274-1283. doi: 10.1007/s11999-014-4048-1.
- Fontainhas P., Govardhan R.H. Femoral Head Reduction Osteotomy for Deformed Perthes Head Using Ganz Safe Surgical Dislocation of Hip — A Case Report with 3-Year Follow-up. J Orthop Case Rep. 2020;10(6):32-35. doi: 10.13107/jocr.2020.v10.i06.1864.
- Камоско М.М., Баиндурашвили А.Г. Диспластический коксартроз у детей и подростков (клиника, патогенез, хирургическое лечение). СПб.: СпецЛит; 2010. С. 54-72. Kamosko M.M., Baindurashvili A.G. Dysplastic hip osteoarthritis in children and adolescents (clinical picture, pathogenesis, surgical treatment). Saint-Petersburg: SpetsLit; 2010. P. 54-72. (In Russian).
- Тепленький М.П., Бунов В.С., Фозилов Д.Т. Сустав- сберегающие операции у пациентов с ацетабулярной дисплазией, осложненной нарушением сферичности головки бедра. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2023;30(4):409-418. doi: 10.17816/vto568718. Teplenky M.P., Bunov V.S., Fozilov J.T. Joint-sparing surgery in patients with acetabular dysplasia complicated by sphericity of the femoral head. N.N. Priorov Journal of Traumatology and Orthopedics. 2023;30(4):409-418. (In Russian). doi: 10.17816/vto568718.
- Nehme A., Trousdale R., Tannous Z., Maalouf G., Puget J., Telmont N. Developmental dysplasia of the hip: is acetabular retroversion a crucial factor? Orthop Traumatol Surg Res. 2009;95(7):511-519. doi: 10.1016/j.otsr.2009.06.006.
- Jones D.H. Shenton’s line. J Bone Joint Surg Br. 2010; 92(9):1312-1315. doi: 10.1302/0301-620X.92B9.25094.
- Yonga Ö., Memişoğlu K., Onay T. Early and mid-term results of Tönnis lateral acetabuloplasty for the treatment of developmental dysplasia of the hip. Jt Dis Relat Surg. 2022;33(1):208-215. doi: 10.52312/jdrs.2022.397.
- Vahedi H., Alvand A., Kazemi S.M., Azboy I., Parvizi J. The ‘low-volume acetabulum’: dysplasia in disguise. J Hip Preserv Surg. 2018;5(4):399-403. doi: 10.1093/jhps/hny036.
- Бортулева О.В., Басков В.Е., Бортулев П.И. Барсуков Д.Б., Поздникин И.Ю. Реабилитация подростков после хирургического лечения диспластического коксартроза. Ортопедия, травматология и восстановительная хирургия детского возраста. 2018;6(1):45-50. doi: 10.17816/PTORS6145-50. Bortuleva O.V., Baskov V.E., Bortulev P.I., Barsukov D.B., Pozdnikin I.Yu. Rehabilitation of adolescents after surgical treatment of dysplastic coxarthrosis. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2018;6(1):45-50. (In Russian). doi: 10.17816/PTORS6145-50.
- Herring J.A. Legg-Calvé-Perthes disease at 100: a review of evidence-based treatment. J Pediatr Orthop. 2011;31(2 Suppl):S137-S140. doi: 10.1097/BPO.0b013e318223b52d.
- Stulberg S.D., Cooperman D.R., Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63(7):1095-1108.
- Bhuyan B.K. Early outcomes of one-stage combined osteotomy in Legg-Calvé-Perthes disease. Indian J Orthop. 2016;50(2):183-194. doi: 10.4103/0019-5413.177581.
- Wiig O., Terjesen T., Svenningsen S. Prognostic factors and outcome of treatment in Perthes’ disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. 2008;90(10):1364-1371. doi: 10.1302/0301-620X.90B10.20649.
- Shah H. Perthes disease: evaluation and management. Orthop Clin North Am. 2014;45(1):87-97. doi: 10.1016/j.ocl.2013.08.005.
- Rodríguez-Olivas A.O., Hernández-Zamora E., Reyes-Maldonado E. Legg-Calvé-Perthes disease overview. Orphanet J Rare Dis. 2022;17(1):125. doi: 10.1186/s13023-022-02275-z.
- Богопольский О.Е., Трачук П.А., Специальный Д.В., Середа А.П., Тихилов Р.М. Результаты артроскопического лечения фемороацетабулярного импинджмента. Травматология и ортопедия России. 2022;28(4):54-65. doi: 10.17816/2311-2905-1980. Bogopolskiy O.E., Trachuk P.A., Spetsialnyi D.V., Sereda A.P., Tikhilov R.M. Results of Arthroscopic Treatment for Femoroacetabular Impingement. Traumatology and Orthopedics of Russia. 2022;28(4): 54-65. (In Russian). doi: 10.17816/2311-2905-1980.
- Бортулёв П.И., Виссарионов С.В., Баиндурашвили А.Г., Неверов В.А., Басков В.Е., Барсуков Д.Б. и др. Анализ причин выполнения тотального эндопротезирования тазобедренного сустава у детей: часть 1. Травматология и ортопедия России. 2024;30(2):54-71. doi: 10.17816/2311-2905-17527. Bortulev P.I., Vissarionov S.V., Baindurashvili A.G., Neverov V.A., Baskov V.E., Barsukov D.B. et al. Causes of Total Hip Replacement in Children: Part 1. Traumatology and Orthopedics of Russia. 2024;30(2):54-71. (In Russian). doi: 10.17816/2311-2905-17527.
- Kanatli U., Ayanoglu T., Ozer M., Ataoglu M.B., Cetinkaya M. Hip arthroscopy for Legg-Calvè-Perthes disease in paediatric population. Acta Orthop Traumatol Turc. 2019;53(3):203-208. doi: 10.1016/j.aott.2019.03.005.
- Lee W.Y., Hwang D.S., Ha Y.C., Kim P.S., Zheng L. Outcomes in patients with late sequelae (healed stage) of Legg-Calvé-Perthes disease undergoing arthroscopic treatment: retrospective case series. Hip Int. 2018;28(3):302-308. doi: 10.5301/hipint.5000563.
- Goyal T., Barik S., Gupta T. Hip Arthroscopy for Sequelae of Legg-Calve-Perthes Disease: A Systematic Review. Hip Pelvis. 2021;33(1):3-10. doi: 10.5371/hp.2021.33.1.3.
- Chaudhary M.M., Chaudhary I.M., Vikas K.N., KoKo A., Zaw T., Siddhartha A. Surgical hip dislocation for treatment of cam femoroacetabular impingement. Indian J Orthop. 2015;49(5):496-501. doi: 10.4103/0019-5413.164040.
- Khalifa A.A., Hassan T.G., Haridy M.A. The evolution of surgical hip dislocation utilization and indications over the past two decades: A scoping review. Int Orthop. 2023;47(12):3053-3062. doi: 10.1007/s00264-023-05814-w.
- Leibold C.S., Vuillemin N., Büchler L., Siebenrock K.A., Steppacher S.D. Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg-Calve-Perthes disease. Oper Orthop Traumatol. 2022;34(5):352-360. doi: 10.1007/s00064-022-00780-9.
- Leunig M., Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S62-67.
- Govardhan P., Govardhan R.H. Femoral Head Reduction Osteotomy for Deformed Perthes Head Using Ganz Safe Surgical Dislocation of Hip - A Case Report with 3-Year Follow-up. J Orthop Case Rep. 2020;10(6):32-35. doi: 10.13107/jocr.2020.v10.i06.1864.
- Kalenderer Ö., Erkuş S., Turgut A., İnan İ.H. Preoperative planning of femoral head reduction osteotomy using 3D printing model: A report of two cases. Acta Orthop Traumatol Turc. 2019;53(3):226-229. doi: 10.1016/j.aott.2019.01.002.
- Paley D. The treatment of femoral head deformity and coxa magna by the Ganz femoral head reduction osteotomy. Orthop Clin North Am. 2011;42(3):389-399. doi: 10.1016/j.ocl.2011.04.006.
- Slongo T., Ziebarth K. Femoral head reduction osteotomy to improve femoroacetabular containment in Legg-Calve-Perthes disease. Oper Orthop Traumatol. 2022;34(5):333-351. (In German). doi: 10.1007/s00064-022-00779-2.
- Eltayeby H.H., El-Adwar K.L., Ahmed A.A., Mosa M.M., Standard S.C. Femoral head reduction osteotomy for the treatment of late sequela of Legg-Calvé-Perthes disease and Perthes-like femoral head deformities. J Pediatr Orthop B. 2024;33(4):348-357. doi: 10.1097/BPB.0000000000001109.
- Clohisy J.C., Pascual-Garrido C., Duncan S., Pashos G., Schoenecker P.L. Concurrent femoral head reduction and periacetabular osteotomies for the treatment of severe femoral head deformities. Bone Joint J. 2018;100-B(12):1551-1558. doi: 10.1302/0301-620X.100B12.BJJ-2018-0030.R3.
- Gharanizadeh K., Ravanbod H., Aminian A., Mirghaderi S.P. Simultaneous femoral head reduction osteotomy (FHRO) combined with periacetabular osteotomy (PAO) for the treatment of severe femoral head asphericity in Perthes disease. J Orthop Surg Res. 2022;17(1):461. doi: 10.1186/s13018-022-03351-7.
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