Femoral versus Acetabular Containment Procedures in Perthes Disease: A Systematic Review and Meta-analysis

Abstract

Abstract Background Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of femur is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis. There is limited data about surgical options in treatment of Perthes disease. The authors conducted this systematic review and meta-analysis to compare between femoral versus acetabular containment in the management of Perthes disease in terms of efficacy and complications, however there is a debate about the ideal way of treatment in Perthes disease. Objective To compare between femoral varus and acetabular containment osteotomies in children with Perthes disease, regarding the efficacy, long-term outcomes and complications. Methods This systematic review and meta-analysis examined studies that compared FVO and Pelvic Osteotomy. The authors searched the Medline database via PubMed, EMBASE, and Cochrane Library for studies published between 2012 and 2022. Results A total of 1051 patients were analyzed for different procedures, including 429 patients in the pelvic arm, 459 patients in FVO arm, and 163 patients in the combined arm. The number of hips included in the current analysis was 1069 hips, including 437 in pelvic arm, 469 in FVO arm, and 163 in the combined arm. The mean age for the included patients was 9.5±7.74 years, with 859 (81.8%) males and 192 (18.2%) females. There was an apparent predominance in males vs. females in all arms. The mean follow-up of the included studies was 8.6±8.32 years. We compared between the three procedures clinically, radiographic and complications. (FVO: Femoral varus osteotomy). Conclusion Femoral varus osteotomy and Pelvic osteotomy have shown comparable clinical and radiological improvement in treatment of perthes disease. The FVO group has shown higher rate than pelvic or combined osteotomies regarding post-operative arthritis and decrease range of motion. The pelvic group has shown higher rate than FVO and combined osteotomies regarding post-operative impingement and leg length discrepancy. There was no significant difference between the pelvic, femoral and combined osteotomies regarding range of motion, Trendelenberg, limping, post-operative pain and secondary knee deformity. In summary, this review provides evidence that femoral and pelvic osteotomies are safe, effective methods in treatment.