CORR Insights®: Isolated Trochanteric Descent and Greater Trochanteric Apophyseodesis Are Not Effective in the Treatment of Post-Perthes Deformity.

Abstract

Osteonecrosis of the femoral head in children, known as Legg-Calvé-Perthes disease (LCPD), behaves unpredictably [1, 5, 9]. A long list of factors can influence the surgeon’s treatment options, including age of the onset, size of the lesion, femoral head subluxation, presence or absence of greater trochanter hypertrophy, premature growth plate arrest, bilaterality, limitation of hip motion (particularly in abduction). Surgeons can use radiographs to diagnose LCPD, although MRI has proven more useful [2, 12]. There is a debate regarding the choice of treatment for patients in the Herring B, B/C, or C groups, and among patients with Catterall Group III or IV LCPD [5, 9, 16]. Using the Stulberg classification, which has prognostic implications for further function and development of hip degeneration [5, 9, 16], comparable results have been found at the end of growth whether we treat LCPD with non-surgical containment treatment methods or surgically. Hypertrophy of the greater trochanter in the course of LCPD sometimes results in shortening of the resting length and lever arm of the abductors, leading to functional hip weakness and/or restricting the abduction in the hip joint. To assess greater trochanteric hypertrophy, we can use articulotrochanteric distance, articulotrochanteric distance index, and center-trochanteric distance [3, 6, 13]. Two surgical procedures—greater trochanteric apophyseodesis and greater trochanteric descent—have been used to try to prevent this condition, which can impair functional hip biomechanics [4, 8, 15]. The current study by Haskel and colleagues [7] quantifies the change in the hip joint morphology and strength of gluteus muscles under greater trochanteric apophyseodesis or greater trochanteric descent and compared those changes with patients who did not have surgery. Even after surgical treatment, neither greater trochanteric apophyseodesis nor greater trochanteric descent improved the neck-shaft angle, neck length, Stulberg type, or gluteus muscle strength of patients with LCPD compared with those treated non-surgically [7].