دورية أكاديمية
Predictors of Persistent Limp Following Proximal Femoral Varus Osteotomy for Perthes Disease.
| العنوان: | Predictors of Persistent Limp Following Proximal Femoral Varus Osteotomy for Perthes Disease. |
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| المؤلفون: | Orellana KJ; Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA., Bram JT; Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA., Batley M; Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA., Novotny S; Department of Orthopaedic Surgery, Gillete Children's Specialty Healthcare, St. Paul., Shah H; Department of Paediatric Orthopaedics, Kasturba Medical College, Karnataka, Manipal, India., Laine JC; Department of Orthopaedic Surgery, Gillete Children's Specialty Healthcare, St. Paul.; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN., Kelly DM; Department of Orthopaedic Surgery, The University of Tennessee Health Science Center-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN., Martin B; Department of Orthopaedic Surgery, Division of Orthopaedic Surgery & Sports Medicine, Children's National Hospital, Washington, DC., Schrader T; Department of Orthopaedic Surgery, Children's Healthcare Atlanta, Atlanta, GA., Kim H; Department of Orthopaedic Surgery, Texas Scottish Rite for Children.; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX., Sankar WN; Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA. |
| مؤلفون مشاركون: | International Perthes Study Group |
| المصدر: | Journal of pediatric orthopedics [J Pediatr Orthop] 2024 Aug 01; Vol. 44 (7), pp. e618-e624. Date of Electronic Publication: 2024 Apr 25. |
| نوع المنشور: | Journal Article; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8109053 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-2570 (Electronic) Linking ISSN: 02716798 NLM ISO Abbreviation: J Pediatr Orthop Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2000- : Philadelphia : Lippincott Williams & Wilkins Original Publication: New York Ny : Raven Press |
| مواضيع طبية MeSH: | Legg-Calve-Perthes Disease*/surgery , Legg-Calve-Perthes Disease*/diagnostic imaging , Osteotomy*/methods , Osteotomy*/adverse effects, Humans ; Child ; Male ; Female ; Retrospective Studies ; Risk Factors ; Femur/surgery ; Femur/diagnostic imaging ; Postoperative Complications/etiology ; Follow-Up Studies |
| مستخلص: | Introduction: One of the most popular containment procedures for Legg-Calvé-Perthes disease (LCPD) is proximal femur varus osteotomy (PFO). While generally successful in achieving containment, PFO can cause limb length discrepancy, abductor weakness, and (of most concern for families) a persistent limp. While many studies have focused on radiographic outcomes following containment surgery, none have analyzed predictors of this persistent limp. The aim of this study was to determine clinical, radiographic, and surgical risk factors for persistent limp 2 years after PFO in children with LCPD. Methods: A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 years at disease onset with unilateral early-stage LCPD (Waldenström I) who underwent PFO. Limp status (no, mild, and severe), age, BMI, and pain scores were obtained at initial presentation, 3-month, and 2-year postoperative visits. Preoperative and follow-up radiographs were used to measure traditional morphologic hip metrics including acetabular index (AI), lateral center-edge angle (LCEA), and femoral neck-shaft angle (NSA). Univariate analysis as well as multivariate logistic regression models were used to analyze factors associated with mild and severe limp at the 2-year visit. Results: A total of 95 patients met the inclusion criteria, and of these 50 patients underwent concomitant greater trochanter apophysiodesis (GTA) at the time of PFO. At the 2-year visit, there were 38 patients (40%) with a mild or severe limp. Multivariate logistic regression revealed no significant radiographic factors associated with a persistent limp. However, lower 2-year BMI and undergoing GTA were associated with decreased rates of persistent limp regardless of age ( P <0.05). When stratifying by age of disease onset, apophysiodesis appeared to be protective against any severity of limp in patients aged 6 to 8 years old ( P = 0.03), but not in patients 8 years or older ( P = 0.49). Conclusions: Persistent limp following PFO is a frustrating problem that was seen in 40% of patients at 2 years. However, lower follow-up BMI and performing a greater trochanter apophysiodesis, particularly in patients younger than 8 years of age, correlated with a lower risk of postoperative limp. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
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| فهرسة مساهمة: | Investigator: S Yang; JC Abril; M Abouassaly; C Selberg; I Swarup; LRA de Angeli; SR Merckaert; V Casey; S Gilbert; R Guarniero; T Herring; J Janicki; J Kessler; K Mulpuri; S Rosenfeld; B Shore; M Thacker; E Fornari; L Meiss; R Goldstein; S Upasani; P Moreno; Y Hailer; B Vakulenko-Lagun; SA Novotny; W Morris |
| تواريخ الأحداث: | Date Created: 20240425 Date Completed: 20240710 Latest Revision: 20240710 |
| رمز التحديث: | 20240710 |
| DOI: | 10.1097/BPO.0000000000002706 |
| PMID: | 38659309 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1539-2570 |
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| DOI: | 10.1097/BPO.0000000000002706 |