Combination trochanteric arrest and intertrochanteric osteotomy for Perthes' disease.

Abstract

A significant complication associated with femoral varus osteotomy (FVO) is trochanteric overgrowth and concomitant abductor weakness. We identified 28 patients who underwent unilateral FVO for Perthes' disease, had a healed femoral head on their latest radiograph, and had at least 2.1 years of follow-up. The patients were divided into two groups; group 1: patients who did not receive prophylactic trochanteric arrest (TA) at the time of FVO; group 2: patients who did receive TA. Clinical parameters were quantified using objective measurements and a scoring system for reported symptoms. At postoperative follow-up, group 2 had greater articulotrochanteric distance (ATD), better range of motion, less abductor weakness, less pain, and superior activity levels. These differences were statistically significant. This study demonstrates that when properly performed with respect to indications and timing, the combination of TA and FVO provides an effective means of managing Perthes' disease when "head at risk" signs are present. The authors include a detailed discussion of surgical technique.