COMBINED PELVIC AND FEMORAL OSTEOTOMY IN THE TREATMENT OF STULBERG TYPE IV PERTHES DISEASE

Abstract

Introduction: We describe the successful treatment of advanced Perthes’ disease in 5 patients using a combined pelvic and femoral osteotomy. To our knowledge, there are no reports in orthopaedic literature describing simultaneous pelvic and femoral osteotomy as treatment for healed Perthes disease.

Method: There were 4 males and 1 female, age range 10 years to 18 years (mean 13 years). All five patients were rated as Stulberg IV. We used a Tonnis pelvic osteotomy and a 20° valgus femoral osteotomy. Clinical parameters, measured pre and post operatively, included range of movement, Harris hip and pain scores (patient and parent perception of pain on an analogue scoring system).

Results: The mean improvement in Harris hip score was 30 points and the mean reduction in pain score was 6. Range of movement was not affected. Complications included one case of non-union of the femoral osteotomy, successfully treated by open reduction and internal fixation with bone graft.

Conclusions: Simultaneous pelvic and femoral osteotomy may improve symptoms and function in symptomatic patients with healed Stulberg IV Perthes disease