How justified is simultaneous femoral head reduction osteotomy and triple pelvic osteotomy in children with perthes disease?

Background. At the current stage of reconstructive orthopedics, femoral head reduction osteotomy in patients with severe aspherical deformation of the femoral head (Stulberg classes IV-V) remains the only effective surgical procedure capable of providing a favorable long-term outcome. However, in the vast majority of cases, secondary hip subluxation develops in the early postoperative period. In this context, simultaneous performance of femoral head reduction osteotomy and triple pelvic osteotomy appears to be a logical option. The aim of the study — to perform a clinical and radiographic analysis of the outcomes of simultaneous femoral head reduction osteotomy and triple pelvic osteotomy in children with Perthes disease and Stulberg class IV-V femoral head deformity, as well as to assess the invasiveness of the procedure. Methods. The study was based on the analysis of clinical, radiographic, and laboratory data from 25 patients (25 hip joints) aged 8 to 12 years with Stulberg class IV-V femoral head deformity due to Perthes disease. All patients were divided into two groups. Group I included 15 patients who underwent simultaneous femoral head reduction osteotomy and triple pelvic osteotomy. Group II consisted of 10 patients who underwent triple pelvic osteotomy as the second stage due to the development of secondary hip subluxation. Results. A comprehensive assessment of surgical invasiveness revealed no statistically significant differences. At a follow-up period of at least 6 months after surgery, all patients in Group I demonstrated a marked improvement in the femoral head shape, as well as the restoration of the articular surface congruency with adequate hip joint stability. In Group II, hip subluxation was eliminated. However, some patients required a greater degree of acetabular fragment correction. Conclusion. Simultaneous femoral head reduction osteotomy and triple pelvic osteotomy enables the restoration of the articular surface congruency while minimizing the risk of secondary hip subluxation. Moreover, this combined approach does not demonstrate excessive invasiveness compared with other surgical procedures performed via an anterolateral approach.