Does Relative Femoral Neck Lengthening Improve Outcomes in Sequelae of Perthes Disease?: A Systematic Review

Purpose: Osteochondroplasty and femoral neck osteotomy can be used in conjunction with surgical hip dislocation (SHD) for added benefit to patients with sequelae of Perthes disease. The aim of the current systematic review was to provide a critical analysis of the literature and present the outcomes of SHD with relative femoral neck lengthening in sequelae of Perthes disease. Materials and Methods: Electronic database searches with relevant keywords were conducted in PubMed and Embase. This review included studies which described relative femoral neck lengthening outcomes on sequelae of Perthes disease. A study required a minimum postoperative follow-up period of one year for inclusion in this review. Results: Seven retrospective studies with 244 patients were included in the review. Five studies reported objective improvement in functional scores. Approximately 9% (12/137) of patients reported complications and the overall pooled proportion of patients requiring subsequent total hip arthroplasty was 8% (95% confidence interval with a range of 4% to 11%). Conclusion: Used in conjunction with relative femoral neck lengthening SHD has opened a new treatment means for the correction of deformities resulting from sequelae of Perthes disease. Notable improvements in clinical and functional outcomes can be expected after this procedure. Low rates of postoperative complications and future conversions to total hip arthroplasty were also noted. The results of the review are limited by the non-uniform inclusion of study participants in terms of preoperative grading as well as any occurrence of prior, concomitant or subsequent surgical procedures.