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Midterm results after subtrochanteric end-to-side valgization osteotomy in severe infantile coxa vara
Christian M J Günther1, Moritz Komm, Volkmar Jansson
1Department of Orthopaedic Surgery, University Hospital of Munich (LMU) Campus, Munich, Germany.
Insights
Subtrochanteric end-to-side valgization osteotomy effectively treats severe infantile coxa vara, improving clinical outcomes and healing nonunions. This procedure is safer and more efficient than the Y-shaped osteotomy.
Area of Science:
- Orthopaedic surgery
- Pediatric orthopaedics
- Hip biomechanics
Background:
- Severe infantile coxa vara requires understanding hip mechanobiology before and after surgical intervention.
- Subtrochanteric end-to-side valgization osteotomy is presented as a treatment option.
- Comparison is made with the Pauwels Y-shaped osteotomy.
Purpose of the Study:
- To evaluate the effectiveness of subtrochanteric end-to-side valgization osteotomy in managing severe infantile coxa vara.
- To compare the outcomes of this procedure with the Y-shaped osteotomy.
Main Methods:
- A case-control study (EBM-level III) involving 13 patients (20 hips) with a mean follow-up of 6.2 years.
- Analysis of pelvic radiographs assessing 30 angles and distances.
- Etiologies included congenital coxa vara, osteochondrodysplasias, postosteomyelitic coxa vara, and avascular femoral head necrosis.
Main Results:
- Significant improvement in Trendelenburg's sign (12 to 2 patients) and Duchenne's limp (10 to 1).
- All 15 preoperatively apparent nonunions healed post-surgery.
- Minor revarization tendencies observed in 2 hips, with one requiring revision.
Conclusions:
- Subtrochanteric end-to-side valgization osteotomy is highly effective for infantile coxa vara, improving clinical impairment.
- The procedure demonstrates excellent osseous consolidation and is technically less demanding, safer, and more efficient than the Y-shaped intertrochanteric osteotomy.
Background:
For the treatment of the severe infantile coxa vara it is mandatory for the orthopaedic surgeon to observe the mechanobiology of the growing hip before and after the surgical intervention. We hereby would like to present our experiences with the subtrochanteric end-to-side valgization osteotomy and to compare the procedure with the alternatively used Y-shaped osteotomy as described by Pauwels.
Methods:
Thirteen patients (20 hips) who had undergone subtrochanteric end-to-side valgization were followed for a mean 6.2 years (range, 0.8 to 12.8 y). At the time of surgery the mean age was 7.1 years (range, 2.0 to 13.3 y), last follow-up examination was performed at a mean of 13.4 years of age (range, 5.1 to 18.3 y). The deformities were etiologically based on 5 entities: congenital coxa vara (n=1), osteochondrodysplasias (n=12), postosteomyelitic coxa vara (n=5), and avascular femoral head necrosis in the course of congenital dysplasia of the hip (n=2). The follow-up rate was 100%.In addition, we analyzed a total of 93 pelvic radiographies with a total of 139 hip joints. Thirty angles and distances were assessed according to parameters described in the literature.
Results:
Although preoperatively 12 patients presented with a positive Trendelenburg's sign, it was only present postoperatively in 2 patients. Duchenne's limp reduced from 10 to 1. All of the 15 preoperatively apparent nonunions could be healed by means of surgery. Two hips redeveloped pathologically lowered collodiaphyseal angles postoperatively, one of which had to undergo revision surgery. Preoperatively 15 out of 20 patients (75%) showed nonunions all of which healed after surgery. No recurrence could be seen at the time of the last follow-up.The following angles were assessed on plain radiographies of the pelvis preoperatively and directly postoperatively as well as on the last follow-up at a mean of 85 months: CCD-angle 98 degrees/156 degrees/144 degrees, EY-angle 55 degrees/5 degrees/15.7 degrees, AY-angle 32 degrees/75 degrees/66 degrees, CE-angle 20 degrees/25 degrees/18 degrees, AC-angle 20 degrees/18 degrees/20 degrees. The articulotrochanteric distance was 5 mm/26 mm/14 mm.
Conclusions:
The subtrochanteric end-to-side valgization osteotomy showed to be highly effective in the management of the infantile coxa vara, improving the clinical impairment of the patients postoperatively. All of the preoperatively present nonunions showed osseous consolidation at follow-up examination. Only minor revarization tendencies could be found. The procedure is technically less demanding, safer and more efficient regarding the lengthening of the affected limb in comparison to the Y-shaped intertrochanteric osteotomy as described by Pauwels.
Level Of Evidence:
Case-control study (EBM-level III).
