Which is a better method for Perthes' disease: femoral varus or Salter osteotomy?

The optimum surgical treatment of patients with Perthes' disease has not been decided. We compared the clinical and radiographic results at skeletal maturity of the femoral varus osteotomy and the Salter innominate osteotomy for treatment of patients with Perthes' disease. Treatment in 46 patients was by femoral varus osteotomy and in 30 patients by Salter innominate osteotomy. There were no significant differences between the two groups. The clinical results were similar in the two groups except for scarring after surgery, which was more prominent in the femoral varus osteotomy group. There was no significant difference in the sphericity of the femoral head and congruity of the hip between the two groups. However, coverage of the femoral head by the acetabulum, the neck-shaft angle, and the articular-trochanteric distance were closer to normal in the Salter innominate osteotomy group. We think that the Salter innominate osteotomy is the better treatment for patients with Perthes' disease to decrease residual problems such as coxa vara, trochanteric prominence, poor acetabular coverage, and the surgical scar.

Therapeutic study, Level IV (case series-no, or historical control group).