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Short Term Outcome of Varus Derotation Osteotomy in Late Presenting Perthes Disease

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Abstract

Background

Untreated Perthes disease can lead to osteoarthritis by the fourth decade. The treatment is conservative for children <6 years, operative within the age group of 6–9 years. Late onset Perthes, older than 9 years or more, are notorious with the aggressive course with poor outcome. However, literature do not come to a consensus between conservative and operative management. This study evaluates the clinical and radiological outcome of varus derotation osteotomy (VDRO) in Perthes disease presenting late with age 8 years or more.

Materials and Methods

15 children (13 males and 2 females) with the mean age of 9.4 years belonging to modified Elizabethtown classification Stage IB, IIA, IIB treated with open wedge VDRO between 2008 and 2014 were included in this study. Seven patients (46.67%) were of >10 years of age at presentation. All patients had limitation of abduction and internal rotation. Eight patients (53.33%) had pain at the hip and 12 patients (80%) had limp. Mean time between diagnosis and corrective surgery was 3 weeks.

Results

The evaluation was done using caput index (CI) and epiphyseal quotient (EQ) and articulotrochanteric distance radiologically, range of motion and Harris Hip Score for clinical outcome. All the measurements were carried out on pre- and postoperative X-rays after 3 years followup and compared with the contralateral normal hip. After a mean followup period of 3.4 years, we noted the statistically significant difference between pre- and postoperative values. We noted that all (100%) children in Stage IB, IIA and 50% children in Stage IIB achieved satisfactory results. There was a significant change (P = 0.000) in CI among all the patients after surgery. The final EQ after 3 years of VDRO was 0.606 and was significant (P = 0.0000).

Conclusion

In our opinion, based on the encouraging short term radiological and clinical outcomes, VDRO may be regarded as a treatment procedure for late presenting Perthes disease in stage IB, IIA, IIB.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

    Soumya Shrikanta Mohapatra (Senior Resident)

  2. C/O: Mr. Balram Sharma, 263/1, Civil Lines, 122 001, Baraf Khana, Gurgaon, Haryana, India

    Soumya Shrikanta Mohapatra (Senior Resident)

  3. Department of Orthopaedics and Traumatology, SMS Medical College, Jaipur, Rajasthan, India

    Narendra Joshi, Mahaveer Prasad Goyal, Shiv Kumar Goyal, Rakesh Kumar & Mukesh Saini

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  1. Narendra Joshi
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  2. Soumya Shrikanta Mohapatra
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  3. Mahaveer Prasad Goyal
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  4. Shiv Kumar Goyal
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  6. Mukesh Saini
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Correspondence to Soumya Shrikanta Mohapatra.

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Joshi, N., Mohapatra, S.S., Goyal, M.P. et al. Short Term Outcome of Varus Derotation Osteotomy in Late Presenting Perthes Disease. IJOO 52, 133–139 (2018). https://doi.org/10.4103/ortho.IJOrtho_196_16

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  • DOI: https://doi.org/10.4103/ortho.IJOrtho_196_16

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