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A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip

Proximal femoral varus osteotomy (PFVO) is a common procedure performed in children with developmental dysplasia of the hip (DDH) and Legg–Calvé–Perthes disease (LCPD). However, the long-term effect on angular deformities of the knees and ankles following PFVO remains controversial. This study inves...

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Autores principales: Liu, Kuei-Yu, Wu, Kuan-Wen, Lee, Chia-Che, Lin, Sheng-Chieh, Kuo, Ken N., Chang, Jia-Feng, Wang, Ting-Ming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020772/
https://www.ncbi.nlm.nih.gov/pubmed/35463899
http://dx.doi.org/10.3389/fped.2022.835447
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author Liu, Kuei-Yu
Wu, Kuan-Wen
Lee, Chia-Che
Lin, Sheng-Chieh
Kuo, Ken N.
Chang, Jia-Feng
Wang, Ting-Ming
author_facet Liu, Kuei-Yu
Wu, Kuan-Wen
Lee, Chia-Che
Lin, Sheng-Chieh
Kuo, Ken N.
Chang, Jia-Feng
Wang, Ting-Ming
author_sort Liu, Kuei-Yu
collection PubMed
description Proximal femoral varus osteotomy (PFVO) is a common procedure performed in children with developmental dysplasia of the hip (DDH) and Legg–Calvé–Perthes disease (LCPD). However, the long-term effect on angular deformities of the knees and ankles following PFVO remains controversial. This study investigated the relationship between PFVO and alignment changes in the knee and ankle after the procedure. Twenty-five patients undergoing PFVO procedure with a minimum 4-year evaluation period were enrolled in the study, including 14 unilateral LCPD and 11 unilateral DDH. The standing scanogram examinations were collected before the operation, immediately following surgery, after a 1-year follow-up, after a 3-year follow-up, and at the final visit to the clinic. The radiographic parameters included leg length, femoral neck-shaft angle (FNSA), femorotibial angle (FTA), mechanical axis deviation (MAD), tibiotalar angle (TTA), and mechanical lateral distal femoral angle (mLDFA). At the final examination, FNSA demonstrated insignificant change between the operative and non-operative limbs in the DDH group. Compared with the postoperative result, FNSA significantly improved in the LCPD group (p = 0.039). Both groups did not develop statistical significance in TTA, mLDFA, MAD, and leg length discrepancy after more than a 5-year follow-up. From a biomechanical perspective that the foot passes more medial to the knee under the center of leg mass, varus knee was prone to develop. In order to correct the mechanical axis, the knee reverted to a valgus position gradually. Our study indicates that patients with LCPD or DDH receiving PFVO and Pemberton osteotomy narrow the gap of angular growth in knees and ankles between the operative and non-operative limbs after a long-term follow-up.
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spelling pubmed-90207722022-04-21 A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip Liu, Kuei-Yu Wu, Kuan-Wen Lee, Chia-Che Lin, Sheng-Chieh Kuo, Ken N. Chang, Jia-Feng Wang, Ting-Ming Front Pediatr Pediatrics Proximal femoral varus osteotomy (PFVO) is a common procedure performed in children with developmental dysplasia of the hip (DDH) and Legg–Calvé–Perthes disease (LCPD). However, the long-term effect on angular deformities of the knees and ankles following PFVO remains controversial. This study investigated the relationship between PFVO and alignment changes in the knee and ankle after the procedure. Twenty-five patients undergoing PFVO procedure with a minimum 4-year evaluation period were enrolled in the study, including 14 unilateral LCPD and 11 unilateral DDH. The standing scanogram examinations were collected before the operation, immediately following surgery, after a 1-year follow-up, after a 3-year follow-up, and at the final visit to the clinic. The radiographic parameters included leg length, femoral neck-shaft angle (FNSA), femorotibial angle (FTA), mechanical axis deviation (MAD), tibiotalar angle (TTA), and mechanical lateral distal femoral angle (mLDFA). At the final examination, FNSA demonstrated insignificant change between the operative and non-operative limbs in the DDH group. Compared with the postoperative result, FNSA significantly improved in the LCPD group (p = 0.039). Both groups did not develop statistical significance in TTA, mLDFA, MAD, and leg length discrepancy after more than a 5-year follow-up. From a biomechanical perspective that the foot passes more medial to the knee under the center of leg mass, varus knee was prone to develop. In order to correct the mechanical axis, the knee reverted to a valgus position gradually. Our study indicates that patients with LCPD or DDH receiving PFVO and Pemberton osteotomy narrow the gap of angular growth in knees and ankles between the operative and non-operative limbs after a long-term follow-up. Frontiers Media S.A. 2022-04-06 /pmc/articles/PMC9020772/ /pubmed/35463899 http://dx.doi.org/10.3389/fped.2022.835447 Text en Copyright © 2022 Liu, Wu, Lee, Lin, Kuo, Chang and Wang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Liu, Kuei-Yu
Wu, Kuan-Wen
Lee, Chia-Che
Lin, Sheng-Chieh
Kuo, Ken N.
Chang, Jia-Feng
Wang, Ting-Ming
A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip
title A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip
title_full A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip
title_fullStr A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip
title_full_unstemmed A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip
title_short A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg–Calvé–Perthes Disease and Developmental Dysplasia of the Hip
title_sort long-term study of alignment correction following proximal femoral varus osteotomy and pemberton osteotomy in children with legg–calvé–perthes disease and developmental dysplasia of the hip
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020772/
https://www.ncbi.nlm.nih.gov/pubmed/35463899
http://dx.doi.org/10.3389/fped.2022.835447
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