Long-term follow up of varus osteotomy of the femur in patients with Perthes` disease in Erbil City

  • Zainab Abdulwahab Mohammed Ridha Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
Keywords: Erbil, Perthes disease, Varus osteotomy, Lateral pillar classification, Stulberg classification

Abstract

Background and objective: Perthes disease is a condition in which a self-limiting avascular problem affects the capital epiphysis of the femur with a variable course and outcomes. There are patients who definitely benefit from different treatment courses, either surgical or non-surgical, but better with surgical. This study aimed is to determine the outcome of varus derotational osteotomy procedure in the management of Perthes disease.

Methods: In this retrospective study, which was conducted in the orthopedic department of Erbil teaching hospital, 21 patients (22 hips) with Perthes` disease were enrolled over the period of 10- years, from 2008 to 2018. Varus derotational osteotomy to proximal femur was done for all 22 hips affected by Perthes disease in different radiological stages.

Results: Among the patients, 81.0% were males and right side of the hip was the most predominant (52.4%) affected side. Partial limitation of hip movements with +ve Trendelenburg sign were the main clinical findings (52.4%), especially among those aged ≤8 years, males and left side affected patients (54.5%, 72.7%, and 63.6%, respectively). Subluxation and metaphyseal resorption were the main radiological findings of the head of the femur (36.4% and 31.8%, respectively). Radiological stages of the patients mainly showed early fragmentation, late fragmentation, and early healing stages (27.3%, 27.3%, and 22.7%, respectively). Postoperatively, 59.0% of the patients had a good prognosis (Stulberg grades 1 and 2), while 31.9% had a fair prognosis. Those aged ≤8 years had a better prognosis with a significant statistical association between Stulberg classification and those with lateral pillar B & B/C and early three radiological stages (P = 0.01 and 0.005).

Conclusion: Open wedge varus femoral osteotomy is the treatment of choice and gives good results. The strongest predictor of outcomes is Stulberg classification in relation to age, lateral pillar classification, and preoperative radiological stages of the disease.

References

Weinstein SL, Flyn JM. Pediatric orthopedics. 7th ed. Philadelphia: Wolters Kluwer; 2014. P.1112–64.

Mazloumi SM, Ebrahimzadeh MH, Kachooei AR. Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. Arch Bone Joint Surg 2014; 2(2):86–92.

Joseph B. Management of Perthes’ disease. Indian J Orthop 2015; 49(1):10–6.

Alsufi SM. A comprehensive epidemiological study of Perthes disease in Duhok Governorate. Dyala J Med 2013; 5(2):96–106.

Elgohary HE, Abouelnas BA. Perthes' disease: prediction of the outcome. (Accessed October 1, 2018, at https://www.researchgate.net/publication/ 327013654_Perthes'_disease_prediction_of_the_outcome).

Al-Mukhtar AW, Kareem MJ. Femoral versus derotation osteotomy in management of Perthes disease. Bas J Surg 2003; 9(1):60–70.

Singh A, Srivastava RN, Shukla P, Pushkar A, Ali S. Management of late onset Perthes: Evaluation of distraction by external fixator: 5-Year follow up. Adv Orthop 2014; 2014: 135236.

Nguyen NA, Klein G, Dogbey G, McCourt JB, Mehlman CT. Operative versus non- operative treatments for Legg- Calve-Perthes disease: a meta-analysis. J Pediatr Orthop 2012; 32(7):697–705.

Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five five-year follow-up. J Bone Joint Surg Br 2008; 90(10):1364–71.

Lim KS, MD, Shim JS. Outcomes of combined shelf acetabuloplasty with femoral varus osteotomy in severe Legg-Calve-Perthes (LCP) disease: Advanced containment method for severe LCP disease. Clin Orthop Surg 2015; 7(4):497–504.

Herring JA, Kim HT, Browne R. Legg-Calve'-Perthes disease. Part II. Prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am 2004; 86:2121–34.

Terjesen T, Wiig O, Svenningsen S. Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calve'-Perthes disease. Clin Orthop Relat Res 2012; 470:2394–401.

Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH. The lateral pillar classification of Legg–Calve–Perthes disease. J PediatrOrthop 1992; 12(2):143–50.

St- AmantM, Samir B. Gages sign. (Accessed November 8, 2018, at https://radiopaedia.org/articles/gage-sign).

Alshryda S, Banaszkiewicz PA, Jones S. Postgraduate PaediatricOrthopaedics: The candidate's guide to the FRCS (Tr and Orth) examination. 5thed. Cambridge, United Kingdom: Cambridge University Press; 2014.

Canale ST, Beaty JH. Campbell's operative orthopedics. 12th ed. Philadelphia: Elsevier; 2013.

Joseph B, Nayagam S, Loder R, Torode I. Pediatric orthopedics. A system of decision- making. London: Hoderarnold; 2009. P.463–72.

Stulberg SD. Cooperman DR. Wallensten R. The natural history of Legg- Calve-Perthes disease. J Bone Joint Surg AM 1981; 63:1095.

Mohan-Kumar EG, Yathisha-Kumar GM, Rasheed M A. Outcome of closed wedge varus derotation osteotomy with trochanteric apophysiodesis in Perthes disease. Indian J Orthop 2018; 52:616–24.

Loder RT, Skopelja EN.The Epidemiology and demographics of Legg-Calves-Perthes' disease. ISRN Orthop 2011; 2011:04393.

Shaheen S, Awed A. Perthes Disease, results of conservative at Soba University Hospital. Sudan JMed Sci 2015: 10(3):85–91.

Li WC, Xu RJ. Lateral shelf acetabuloplasty for severe Legg-Calvé-Perthes disease in patients older than 8 years: A mean eleven-year follow-up.Medicine 2016; 95(45):e5272.

Pecquery R, Laville JM, Salmeron F. Legg-Calvé-Perthes disease treatment by augmentationacetabuloplasty. Orthop Traumatol Surg Res 2010; 96(2):166–74.

Iwamoto M, Nakashima Y, Nakamura T, Kohno Y, Yamaguchi R, Takamura K. Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg-Calvé-Perthes disease. J Orthop Sci 2018;23(1):156–60.

Kwang-Won P, Ishani PS, Ashok KR,Tae-Jin L, Hae-Ryong S.Proximal femoral osteotomy in Legg-Calvé-Perthes disease using a monolateral external fixator: surgical technique, outcome, and complications. J Pediatr Orthop B 2017; 26(4):329–35.

Moghadam MH, Moradi A, Omidi-Kashani F. Clinical outcome of femoral osteotomy in patients with Legg-Calve'-Perthes disease. Arch Bone Joint Surg 2013; 1(2):90–3.

Perry DC, Skellorn PJ, Bruce CE. The lognormal age of onset distribution in Perthes' disease: an analysis from a large well-defined cohort. Bone Joint J 2016; 98-B(5):710–4.

Hyman JE, Trupia EP, Wright ML, Matsumoto H, Jo CH, Mulpuri K. Inter observer and intra observer reliability of the modified Waldenström classification system for staging of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 2015; 97(8):643–50.

Published
2020-08-30
How to Cite
Mohammed Ridha, Z. (2020). Long-term follow up of varus osteotomy of the femur in patients with Perthes` disease in Erbil City. Zanco Journal of Medical Sciences (Zanco J Med Sci), 24(2), 176-186. https://doi.org/10.15218/zjms.2020.021
Section
Original Articles