Abstract
Introduction and Aims: In a radiological study we evaluated the outcome of the Chiari osteotomy as a primary method of femoral head containment in patients with Perthes’ disease presenting at the age of eight years or older. Even when Salter’s prerequisites are met, the results of a Salter osteotomy is known to be poor in this group.
Method: Thirteen patients underwent a Chiari osteotomy at a mean age of nine years and four months. The osteotomy was performed before femoral head deformity had occurred. The hip was considered to be at risk because of the late onset of the disease. Measurements were made on the pre-operative x-ray, the pre-operative arthrogram and the latest follow-up x-rays. Patients have been followed up for an average of five years and four months. On the pre-operative arthrogram there was no femoral head deformity or hinging on abduction. At the time of surgery it was too early in the disease process to assign a hip reliably to a particular classification. During the follow-up period, 12 hips manifested as a Catterall group IV. Eleven hips became Herring type B and two Herring type C.
Results: At latest follow-up all hips could be reliably graded according to the Stulberg classification. Currently, eight hips were a Stulberg type II and five a Stulberg type III, but this might change as skeletal maturity is reached. It is clear that none of the hips will be a Stulberg type IV or V, which is seen in a significant number of untreated hips at this age.
Conclusion: The Chiari osteotomy achieves a congruent hip in this specific group of patients where a poor outcome would otherwise be anticipated.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
