Medial percutaneous hemi-epiphysiodesis improves the valgus tilt of the femoral head in developmental dysplasia of the hip (DDH) type-II avascular necrosis

Abstract

Background and purpose Avascular necrosis (AVN) is a major cause of disability after treatment of developmental dysplasia of the hip (DDH), leading to femoral head deformity, acetabular dysplasia, and osteoarthritis in adult life. Type-II AVN is characterized by retarded growth in the lateral aspect of the physis or by premature lateral fusion, which produces a valgus deformity of the head on the neck of the femur. We investigated the effect of medial percutaneous hemi-epiphysiodesis as a novel technique in the treatment of late-diagnosed type-II AVN.Patients and methods 9 patients (11 hips) with a diagnosis of type-II AVN who underwent medial percutaneous hemi-epiphysiodesis after the surgical treatment for DDH were included in the study. 10 patients (12 hips) with the same diagnosis but who did not undergo hemi-epiphysodesis were chosen as a control group. Preoperative and postoperative articulotrochanteric distances, head-shaft angles, CE (center-edge) angles, and physeal inclination angles were measured. The treatment group underwent medial hemi-epiphysodesis at a mean age of 8 years. The mean ages of the treatment group and the control group at final follow-up were 14 and 12 years respectively. The mean duration of follow-up was 5.7 years in the treatment group and 8.3 years in the control group.Results Preoperative articulotrochanteric distance, head-shaft angle, and functional outcome at the final follow-up assessment were similar in the 2 groups. However, preoperative and postoperative CE angles and physeal inclination angles differed significantly in the treatment group (p < 0.05). The final epiphyseal valgus angles were better in the treatment group than in the control group (p = 0.05). The treatment group improved after the operation.Interpretation Medial percutaneous epiphysiodesis performed through a mini-incision under fluoroscopic control is a worthwhile modality in terms of changing the valgus tilt of the femoral head.

Guided growth versus varus osteotomy for type II avascular necrosis following surgery for developmental dysplasia of the hip

“…Later, other studies have shown improved radiological outcomes using the guided growth method. [11][12][13][14] This study is the first to compare guided growth with corrective osteotomy for this particular hip condition. The literature on the management of valgus deformity due to AVN comprises patients already treated by different procedures.…”

“…14 Previous studies have outlined correction of the caput valgum deformity with a substantial decrease in the HSA after guided growth. [11][12][13][14] As for the neck geometry, Peng et al 14 found no significant difference in the NSA at two years postoperatively. In our study, there was a significant decrease in both HSA and NSA in the guided growth group.…”

“…Later, other studies have shown improved radiological outcomes using the guided growth method. 11-14 This study is the first to compare guided growth with corrective osteotomy for this particular hip condition.…”

“…Previous reports have shown satisfactory radiological results using screw hemi-epiphysiodesis for valgus deformities of the proximal femur secondary to AVN in DDH patients. [11][12][13][14][15] However, there is little in the literature comparing these two surgical procedures.…”

Expanded Indications for Guided Growth in Pediatric Extremities

“…An improvement in physeal inclination was demonstrated with growth. 64 The age at surgical intervention depended upon the age of diagnosis of the lateral proximal femoral growth abnormality, which may not occur in hip dysplasia patients until later in childhood.…”