Outcome of Closed Wedge Varus Derotation Osteotomy with Trochanteric Apophysiodesis in Perthes Disease.

Abstract

Perthes disease is a condition in which a self-limiting avascular event affects the capital epiphysis of the femur with a very variable course. It has been shown frequently, however, that there is a group of patients who definitely benefit from containment, either surgical or nonsurgical, better with surgical. We studied midterm to long term outcome of closed wedge varus derotation osteotomy (VDRO) with trochanteric apophysiodesis in Perthes disease. 88 children with mean age of 7.9 ± 2 years, belonging to Herring's lateral pillar Groups B and C treated with VDRO with trochanteric apophysiodesis were included in this study. Radiological evaluation was done using Mose's index, the epiphyseal quotient, the articulotrochanteric distance and center edge angle of Wiberg. Containment was achieved in all patients on postoperative radiographs. At a mean followup of 12 years, good results were obtained in 66, fair in 19, and poor in 3 patients using Catterall's postoperative classification. VDRO is an effective containment method of femoral head for patients belonging to the Herring's Group B and also effective in many patients belonging to Herring's Group C. It is a good procedure to attain containment in children <9 years of age. Trochanteric apophysiodesis reduces risk of limping.