How Does a Femoral Varus Osteotomy Alter the Natural Evolution of Perthes’ Disease?

Joseph, Benjamin and Rao, Narasimha and Mulpuri, Kishore and Varghese, George and Nair, Sreekumaran N (2005) How Does a Femoral Varus Osteotomy Alter the Natural Evolution of Perthes’ Disease? Journal of Pediatric Orthopaedics B, 14. pp. 10-15.

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To study how a femoral osteotomy alters the natural evolution of Perthes’ disease, records and radiographs of640 patients with Perthes’ disease were analyzed. The dataof 314 patients who underwent femoral osteotomy were compared with those of non-operated patients. A new modification of classification of the stages of evolution ofthe disease was used to identify the timing of surgery andto monitor the progress of the disease following urgery.The duration of each stage of the disease,the extent ofepiphyseal extrusion, the extent of widening of the femoral metaphysis and the dimensions of the acetabulum were noted on sequential radiographs. Thechanges in thefemoral epiphysis and metaphysis and changes in the acetabulum were also noted.It was observed that a varusosteotomy clearly alters the natural evolution of Perthes’disease. Of patients who were operated in the stage of a vascular necrosis, 34% bypassed the stage of fragmentation.The duration of thedisease was shorter in thesepatients. The duration of the stage of fragmentation wasreduced in operated children whopassed through thestage of fragmentation. The extent of femoral head extrusion was minimized at the stage when it was mostvulnerable for deformation. Metaphyseal widening and subsequent femoral head enlargement were also minimizedin children who underwent a femoral osteotomy. Thechances of retaining the sphericity of the femoral headwere much higher in those children who had a femoralosteotomy. Thesebeneficial effects of a varus osteotomy,were mostevident when the operation was performed either in the stage of avascular necrosis or in the earlystage of fragmentation.

Item Type: Article
Uncontrolled Keywords: Perthes’ disease, natural evolution, varus osteotomy
Subjects: Medicine > KMC Manipal > Orthopaedics
Depositing User: KMC Manipal
Date Deposited: 13 Jan 2012 10:11
Last Modified: 05 Nov 2016 14:55

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