Clinico-Radiological Outcome of Proximal Femoral Varus Derotation Osteotomy In Legg-Calve-Perthes Disease

Authors: Ananda Mandal, Kiran Kumar Mukhopadhyay, Pratyay Pal, Anindya Sarkar, Amiya Kumar Bera

Keywords: Paediatric Hip, Perthes disease, varus derotation, osteotomy, containment, functional outcome

Abstract: INTRODUCTION: Legg-calve-Perthes disease is a paediatric hip disorder in which a self-limiting avascular event affects the capital epiphysis of the femur, resulting in variable course. Management is usually based on containment concepts, including Petrie cast, femoral osteotomy, innominate osteotomy, and acetabular shelf procedure. The varus derotation osteotomy (VDRO)aims to prevent the progression of osteoarthritis and improve the hip joint's long-term function. METHODS:A retrospective study evaluated the clinical and radiological outcomes of proximal femoral varus derotation osteotomy in Legg-Calve-Perthes disease. Patients who underwent this procedure between 2010 and 2018 were included in the study. Clinical outcomes were assessed using the Harris Hip Score and Numeric Rating Scale(NRS) pain scores. Radiological outcomes were evaluated using pre- and post-operative radiographs to assess femoral head coverage, extrusion, and joint congruency. RESULTS: Preliminary results of the study show promising outcomes following proximal femoral varus derotation osteotomy in Legg-Calve-Perthes disease. Patients reported improved pain, range of motion, and overall hip joint function. Radiological assessments also showed improvements in femoral head coverage, reduced extrusion, and improved joint congruency following the procedure. These results suggest that proximal femoral varus derotation osteotomy is an effective treatment option for Legg-Calve-Perthes disease. CONCLUSION: Proximal femoral varus derotation osteotomy is a valuable surgical intervention in managing Legg-Calve-Perthes disease. This procedure can significantly improve clinical symptoms and radiological outcomes, ultimately improving the long-term function and quality of life for patients with this condition. Patients younger than ten years have a better chance of recovery.