Concomitant prophylactic trochanteric epiphysiodesis may not be an effective procedure for Perthes varus surgery

Prophylactic trochanteric epiphyseodesis is commonly performed with proximal femoral varus osteotomy in Perthes disease to reduce relative trochanteric overgrowth. However, its effectiveness, particularly in children at the typical age for surgical containment, remains unclear.

A retrospective review (2015-2025) evaluated children with Perthes disease who underwent subtrochanteric varus osteotomy with concomitant trochanteric epiphysiodesis. Inclusion criteria were a minimum 2-year follow-up and use of a standardized surgical technique. Radiographic parameters neck shaft angle (NSA), articulo-trochanteric distance ratio (rATD), center-trochanteric distance ratio (rCTD), and abductor lever arm ratio (rLAM) were measured preoperatively and at final follow-up, normalized to the contralateral normal hip. Subgroup analysis was done in children older than 8 years and younger than 8 years.

Sixteen patients (mean age 8.1 years; mean follow-up 5.2 years) met inclusion criteria. NSA decreased significantly following varus osteotomy (p < 0.001). rATD deteriorated markedly from 0.982 to 0.305 (p < 0.001), indicating persistent trochanteric overgrowth despite epiphysiodesis. In contrast, rCTD and rLAM showed no significant change. Subgroup analysis revealed similar patterns across age groups: rATD worsened significantly in both older (>8 years: p = 0.031) and younger children (<8 years: p = 0.010), while rCTD and rLAM remained stable.

Prophylactic trochanteric epiphyseodesis performed during varus osteotomy did not prevent abnormal trochanteric development in Perthes disease. Its limited effectiveness was consistent regardless of age. Although CTD and LAM were preserved, the key parameter reflecting trochanteric overgrowth (ATD) continued to worsen. Routine use of this adjunct procedure during containment surgery may therefore be of limited benefit.