Treatment outcome of dome osteotomy of the pelvis combined with trochanteric advancement for sequelae of Perthes' disease

Abstract

Objective: Disparity in size between femoral head and acetabulum could promote premature degener-ation of the hip joint. The purpose of this study was to report the results of Kawamura's dome osteotomy for acetabular dysplasia due to sequelae of Perthes' disease.Patients and Methods: Fourteen patients (14 hips) operated between 1999 and 2012 were retrospectively reviewed. There were 9 males and 5 females with a mean age of 29 years (range, 15e54 years). Func-tional and radiological results were reviewed at mean follow-up of 9 years (range, 4e12 years).Results: Pain relief was obtained in 13 of 14 (92.8%) patients postoperatively. Good to excellent functional outcome was obtained in 10 of 14 (71.4%) patients. Mean Harris hip score was improved from 63 to 84 (p < 0.05) at the final follow-up. Improvement of limping gait was observed in 10 of 14 (71.4%) patients. Center edge angle improved from mean 24 (11e36 ) preoperatively to mean 35 (27e46 ) postoperatively (p < 0.05), acetabular angle improved from mean 43 (36e49 ) preoperatively to mean 37 (32e44 ) postoperatively (p < 0.05), acetabular head index improved from mean 69% (50e83%) preoperatively to mean 85% (73e100%) postoperatively (p < 0.05). Progression of arthrosis stage occurred in 3 of 14 (21%) patients. None of the hip with preoperative Stulberg III, 2 of 9 hips with Stulberg IV and 2 of 2 hips with Stulberg V needed conversion to total hip arthroplasty during the follow-up.Conclusion: Dome osteotomy of the pelvis combined with trochanteric advancement could give a reasonable treatment outcome for acetabular dysplasia due to Perthes' disease at mid to long-term follow-up. Advanced stage of arthrosis, preoperative Stulberg V and no improvement of limping gait after the surgery possibly associated with poor outcome. Level of evidence: Level IV, therapeutic study.© 2018 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).