How justified is simultaneous femoral head reduction osteotomy and triple pelvic osteotomy in children with Perthes disease?

  • Authors: Bortulev P.1, Baskaeva T.V.2, Rustamov A.N.2, Shmel'kov A.3, Grigoriev A.4, Kornyakov P.5
  • Affiliations:
    1. N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University
    2. H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery
    3. Федеральное государственное бюджетное образовательное учреждение высшего образования «Самарский государственный медицинский университет Министерства здравоохранения Российской Федерации»
    4. Chief Physician of the State Budgetary Health Institution of the Moscow Region «Moscow Regional Clinical Traumatology and Orthopedic Hospital», Moscow,Russia.
    5. Federal Center of Traumatology, Orthopedics and Arthroplasty (Cheboksary) of the Ministry of Health of the Russian Federation
  • Section: СLINICAL STUDIES
  • Submitted: 12.10.2025
  • Accepted: 24.11.2025
  • Published: 24.11.2025
  • URL: https://journal.rniito.org/jour/article/view/17772
  • DOI: https://doi.org/10.17816/2311-2905-17772
  • ID: 17772


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Full Text

Abstract

Purpose - to conduct a clinical and radiological analysis of the results of simultaneous FHRO and triple pelvic osteotomy, as well as to assess the traumaticity of the intervention.

Matherials and methods. The work is based on the analysis of the results of clinical, radiological and laboratory methods of examination of 25 patients (25 hip joints) aged from 8 to 12 years with deformity of the femoral head class IV-V according to Stulberg in Perthes disease. 15 patients (group I) underwent simultaneous FHRO and triple pelvic osteotomy. 10 patients (group II) underwent triple pelvic osteotomy to restore hip joint stability due to the development of secondary hip subluxation after FHRO.

Results. The comprehensive assessment of the traumaticity of surgical procedures performed in both study groups had no significant differences (p<0.05). During the follow-up period of at least 6 months after the surgical treatment, all patients in group I showed a significant improvement in the shape of the head, the proximal femur as a whole, and the restoration of congruence of the articular surfaces with the achievement of adequate hip stability. The subluxation was eliminated in group II patients, however, a number of them required a large degree of correction of the acetabular fragment.

Conslusion. An analysis of the clinical and radiological condition of the hip joint in children with head deformity in Perthes disease, class IV-V according to Stulberg, with a comprehensive assessment of the traumaticity of the intervention showed that simultaneous FHRO and triple pelvic osteotomy can restore congruence of articular surfaces while minimizing the risk of secondary hip subluxation, which eliminates the need for staged reconstructive surgery, and it also does not have excessive traumatism in comparison with other types of reconstructive hip joint interventions performed from anterolateral surgical approach.

About the authors

Pavel Bortulev

N.I. Pirogov Clinic of High Medical Technologies, Saint Petersburg State University

Author for correspondence.
Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817

Врач-травматолог-ортопед травматологического отделение №3 

Russian Federation

Tamila V. Baskaeva

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: tamila-baskaeva@mail.ru
ORCID iD: 0000-0001-9865-2434
Russian Federation, St. Petersburg

Arslan N. Rustamov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: arslan.rustamov1999@mail.ru
ORCID iD: 0009-0001-6710-0327
Russian Federation, St. Petersburg

Andrey Shmel'kov

Федеральное государственное бюджетное образовательное учреждение высшего образования «Самарский государственный медицинский университет Министерства здравоохранения Российской Федерации»

Email: pheniks-fire@mail.ru
ORCID iD: 0000-0001-6900-0824

к.м.н., заведующий детским травматолого-ортопедическим отделением отделением

Alexander Grigoriev

Chief Physician of the State
Budgetary Health Institution of the Moscow Region «Moscow
Regional Clinical Traumatology and Orthopedic Hospital»,
Moscow,Russia.

Email: avgrigoriev@mail.ru
ORCID iD: 0000-0003-4294-8724

Главный врач

Pavel Kornyakov

Federal Center of Traumatology, Orthopedics and Arthroplasty (Cheboksary) of the Ministry of Health of the Russian Federation

Email: pashat-1000@mail.ru
ORCID iD: 0000-0002-7124-5473

Врач-травматолог-ортопед отделения травматологии и ортопедии (детское)

References

  1. Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981 Sep;63(7):1095-108. PMID: 7276045
  2. Mose K. Methods of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis. Clin Orthop Relat Res. 1980 Jul-Aug;(150):103-9. PMID: 7428206
  3. Neyt JG, Weinstein SL, Spratt KF, Dolan L, Morcuende J, Dietz FR, Guyton G, Hart R, Kraut MS, Lervick G, Pardubsky P, Saterbak A. Stulberg classification system for evaluation of Legg-Calvé-Perthes disease: intra-rater and inter-rater reliability. J Bone Joint Surg Am. 1999 Sep;81(9):1209-16. doi: 10.2106/00004623-199909000-00002. PMID: 10505517.
  4. Wiig O, Terjesen T, Svenningsen S. Inter-observer reliability of the Stulberg classification in the assessment of Perthes disease. J Child Orthop. 2007 Jul;1(2):101-5. doi: 10.1007/s11832-007-0020-x. Epub 2007 Apr 28. PMID: 19308481; PMCID: PMC2656716.
  5. Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E. Legg-Calvé-Perthes disease overview. Orphanet J Rare Dis. 2022 Mar 15;17(1):125. doi: 10.1186/s13023-022-02275-z. PMID: 35292045; PMCID: PMC8922924
  6. Terjesen T, Wiig O, Svenningsen S. The natural history of Perthes' disease. Acta Orthop. 2010 Dec;81(6):708-14. doi: 10.3109/17453674.2010.533935. Epub 2010 Nov 11. PMID: 21067434; PMCID: PMC3216081.
  7. Bhuyan BK. Early outcomes of one-stage combined osteotomy in Legg-Calve´-Perthes disease. Indian J Orthop. 2016 Mar-Apr;50(2):183-94. doi: 10.4103/0019-5413.177581. PMID: 27053809; PMCID: PMC4800962.
  8. Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. 2008 Oct;90(10):1364-71. doi: 10.1302/0301-620X.90B10.20649. PMID: 18827249.
  9. Wiig O, Huhnstock S, Terjesen T, Pripp AH, Svenningsen S. The outcome and prognostic factors in children with bilateral Perthes' disease: a prospective study of 40 children with follow-up over five years. Bone Joint J. 2016 Apr;98-B(4):569-75. doi: 10.1302/0301-620X.98B4.36045. PMID: 27037442.
  10. Luceri F, Morelli I, Sinicato CM, Della Grazia A, Verdoni F, Maffulli N, Peretti GM, Curci D. Medium-term outcomes of total hip arthroplasty in juvenile patients. J Orthop Surg Res. 2020 Oct 16;15(1):476. doi: 10.1186/s13018-020-01990-2. PMID: 33066797; PMCID: PMC7566112
  11. Бортулёв П.И., Виссарионов С.В., Баиндурашвили А.Г., Неверов В.А., Басков В.Е., Барсуков Д.Б., Поздникин И.Ю., Баскаева Т.В., Познович М.С., Выриков Д.В., Рыбинских Т.С. Анализ причин выполнения тотального эндопротезирования тазобедренного сустава у детей: часть 1. Травматология и ортопедия России. 2024;30(2):54-71
  12. Bortulev P.I., Vissarionov S.V., Baindurashvili A.G., Neverov V.A., Baskov V.E., Barsukov D.B., Pozdnikin I.Yu., Baskaeva T.V., Poznovich M.S., Vyrikov D.V., Rybinskikh T.S. Causes of Total Hip Replacement in Children: Part 1. Traumatology and Orthopedics of Russia. 2024;30(2):54-71. (In Russian). https://doi.org/10.17816/2311-2905-17527
  13. Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg Br. 1971;53:37–53
  14. Agus H, Kalenderer O, Eryanlmaz G, Ozcalabi IT. Intraobserver and interobserver reliability of Catterall, Herring, Salter-Thompson and Stulberg classification systems in Perthes disease. J Pediatr Orthop B. 2004 May;13(3):166-9. doi: 10.1097/00009957-200405000-00005. PMID: 15083116
  15. Friedlander JK, Weiner DS. Radiographic results of proximal femoral varus osteotomy in Legg-Calvé-Perthes disease. J Pediatr Orthop. 2000;20(5):566-571. doi: 10.1097/00004694-200009000-00004
  16. Барсуков Д.Б., Краснов А.И., Басков В.Е., Поздникин И.Ю., Волошин С.Ю., Баскаева Т.В. и др. Корригирующая остеотомия бедра в комплексном лечении детей с болезнью Легга-Кальве-Пертеса // Гений ортопедии. 2017;23(1):63-70. doi: 10.18019/1028-4427-2017-23-1-63-70.
  17. Barsukov D.B., Krasnov A.I., Baskov V.E., Pozdnikin I.Yu., Voloshin S.Yu., Baskaeva T.V. et al. Corrective femoral osteotomy in the complex treatment of childrenwith Legg-Calve-Perthes disease. Orthopaedic Genius.2017;23(1):63-70 (in Russ).] doi: 10.18019/1028-4427-2017-23-1-63-70.
  18. Kim HK, da Cunha AM, Browne R, Kim HT, Herring JA. How much varus is optimal with proximal femoral osteotomy to preserve the femoral head in Legg-Calvé-Perthes disease? J Bone Joint Surg Am. 2011 Feb 16;93(4):341-7. doi: 10.2106/JBJS.J.00830. PMID: 21325585.
  19. Camurcu IY, Yildirim T, Buyuk AF, Gursu SS, Bursali A, Sahin V. Tönnis triple pelvic osteotomy for Legg-Calve-Perthes disease. Int Orthop. 2015 Mar;39(3):485-90. doi: 10.1007/s00264-014-2585-6. Epub 2014 Nov 25. PMID: 25417791
  20. Fontainhas P, Govardhan RH. Femoral Head Reduction Osteotomy for Deformed Perthes Head Using Ganz Safe Surgical Dislocation of Hip - A Case Report with 3-Year Follow-up. J Orthop Case Rep. 2020 Sep;10(6):32-35. doi: 10.13107/jocr.2020.v10.i06.1864. PMID: 33489965; PMCID: PMC7815667
  21. Leunig M, Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S62-7. PMID: 22035488
  22. Leibold CS, Vuillemin N, Büchler L, Siebenrock KA, Steppacher SD. Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg-Calve-Perthes disease. Oper Orthop Traumatol. 2022 Oct;34(5):352-360. doi: 10.1007/s00064-022-00780-9. Epub 2022 Aug 5. PMID: 35930024; PMCID: PMC9525395
  23. Govardhan P, Govardhan RH. Femoral Head Reduction Osteotomy for Deformed Perthes Head Using Ganz Safe Surgical Dislocation of Hip - A Case Report with 3-Year Follow-up. J Orthop Case Rep. 2020 Sep;10(6):32-35. doi: 10.13107/jocr.2020.v10.i06.1864. PMID: 33489965; PMCID: PMC7815667
  24. Siebenrock KA, Anwander H, Zurmühle CA, Tannast M, Slongo T, Steppacher SD. Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 2015 Apr;473(4):1274-83. doi: 10.1007/s11999-014-4048-1. PMID: 25384430; PMCID: PMC4353505
  25. Slongo T, Ziebarth K. Femurkopfreduktionsosteotomie zur Verbesserung des femoroazetabulären Containments bei Morbus Perthes [Femoral head reduction osteotomy to improve femoroacetabular containment in Legg-Calve-Perthes disease]. Oper Orthop Traumatol. 2022 Oct;34(5):333-351. German. doi: 10.1007/s00064-022-00779-2. Epub 2022 Jul 21. PMID: 35861865; PMCID: PMC9525440.
  26. Eltayeby HH, El-Adwar KL, Ahmed AA, Mosa MM, Standard SC. Femoral head reduction osteotomy for the treatment of late sequela of Legg-Calvé-Perthes disease and Perthes-like femoral head deformities. J Pediatr Orthop B. 2024 Jul 1;33(4):348-357. doi: 10.1097/BPB.0000000000001109. Epub 2023 Jul 19. PMID: 37477108
  27. Бортулёв П.И., Баскаева Т.В., Познович М.С., Барсуков Д.Б., Поздникин И.Ю., Рустамов А.Н. Сегментарная резекция головки бедренной кости при грубой деформации эпифиза и дисконгруэнтности суставных поверхностей у детей с болезнью Пертеса // Травматология и ортопедия России. - 2025. - Т. 31. - №1. - C. 20-33. doi: 10.17816/2311-2905-17645
  28. Bortulev P.I., Baskaeva T.V., Poznovich M.S., Barsukov D.B., Pozdnikin I.Y., Rustamov A.N. Femoral Head Reduction Osteotomy for the Treatment of Severe Femoral Head Deformities and Articular Incongruity in Children with Perthes Disease // Traumatology and Orthopedics of Russia. - 2025. - Vol. 31. - N. 1. - P. 20-33. doi: 10.17816/2311-2905-17645
  29. Clohisy JC, Pascual-Garrido C, Duncan S, Pashos G, Schoenecker PL. Concurrent femoral head reduction and periacetabular osteotomies for the treatment of severe femoral head deformities. Bone Joint J. 2018 Dec;100-B(12):1551-1558. doi: 10.1302/0301-620X.100B12.BJJ-2018-0030.R3. PMID: 30499318
  30. Gharanizadeh K, Ravanbod H, Aminian A, Mirghaderi SP. Simultaneous femoral head reduction osteotomy (FHRO) combined with periacetabular osteotomy (PAO) for the treatment of severe femoral head asphericity in Perthes disease. J Orthop Surg Res. 2022 Oct 20;17(1):461. doi: 10.1186/s13018-022-03351-7. PMID: 36266667; PMCID: PMC9585789
  31. Синеокий А.Д., Плиев Д.Г., Гуацаев М.С., Ефимов Н.Н., Стафеев Д.В., Михайлов К.С., Несинов А.А. Cравнительный анализ биохимических маркеров тканевой травматизации в зависимости от используемого хирургического доступа при ревизионном эндопротезировании тазобедренного сустава // Современные проблемы науки и образования. – 2020. – № 4. ;URL: https://science-education.ru/ru/article/view?id=30092 (дата обращения: 22.09.2025)
  32. Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial. J Arthroplasty. 2017;32(11):3421-3428. doi: 10.1016/j.arth.2017.05.056
  33. Müller M, Tohtz S, Springer I, Dewey M, Perka C. Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Arch Orthop Trauma Surg. 2011;131(2):179-189. doi: 10.1007/s00402-010-1117-0
  34. Тепленький М.П., Бунов В.С., Фозилов Д.Т. Сустав сберегающие операции у пациентов с ацетабулярной дисплазией, осложнённой нарушением сферичности головки бедра // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2023. Т. 30, № 4. С. 409−418. DOI: https://doi.org/10.17816/vto568718
  35. Teplenky MP, Bunov VS, Fozilov JT. Joint-sparing surgery in patients with acetabular dysplasia complicated by sphericity of the femoral head. N.N. Priorov Journal of Traumatology and Orthopedics. 2023;30(4):409−418. DOI: https://doi.org/10.17816/vto568718
  36. Nehme A, Trousdale R, Tannous Z, Maalouf G, Puget J, Telmont N. Developmental dysplasia of the hip: is acetabular retroversion a crucial factor? Orthop Traumatol Surg Res. 2009 Nov;95(7):511-9. doi: 10.1016/j.otsr.2009.06.006. PMID: 19837022.
  37. Jones DH. Shenton's line. J Bone Joint Surg Br. 2010 Sep;92(9):1312-5. doi: 10.1302/0301-620X.92B9.25094. PMID: 20798455
  38. Herring JA. Legg-Calvé-Perthes disease at 100: a review of evidence-based treatment. J Pediatr Orthop. 2011 Sep;31(2 Suppl):S137-40. doi: 10.1097/BPO.0b013e318223b52d. PMID: 21857427
  39. Leunig M, Ganz R. Relative neck lengthening and intracapital osteotomy for severe Perthes and Perthes-like deformities. Bull NYU Hosp Jt Dis. 2011;69 Suppl 1:S62-7. PMID: 22035488
  40. Govardhan P, Govardhan RH. Femoral Head Reduction Osteotomy for Deformed Perthes Head Using Ganz Safe Surgical Dislocation of Hip - A Case Report with 3-Year Follow-up. J Orthop Case Rep. 2020 Sep;10(6):32-35. doi: 10.13107/jocr.2020.v10.i06.1864. PMID: 33489965; PMCID: PMC7815667
  41. Paley D. The treatment of femoral head deformity and coxa magna by the Ganz femoral head reduction osteotomy. Orthop Clin North Am. 2011 Jul;42(3):389-99, viii. doi: 10.1016/j.ocl.2011.04.006. Epub 2011 May 14. PMID: 21742151
  42. Nankaku M PhD Pt, Tsuboyama T PhD Md, Aoyama T PhD Md, Kuroda Y PhD Md, Ikeguchi R PhD Md, Matsuda S PhD Md. Preoperative gluteus medius muscle atrophy as a predictor of walking ability after total hip arthroplasty. Phys Ther Res. 2016 Jul 14;19(1):8-12. doi: 10.1298/ptr.e9884. PMID: 28289576; PMCID: PMC5342965.
  43. Caviglia H, Cambiaggi G, Vattani N, Landro ME, Galatro G. Lesion of the hip abductor mechanism. SICOT J. 2016;2:29. doi: 10.1051/sicotj/2016020. Epub 2016 Jul 6. PMID: 27382925; PMCID: PMC4935799.
  44. Manafi Rasi A, Zandi R, Qoreishi M, Habibollahzadeh A. Magnetic Resonance Imaging Assessment of Hip Abductor after Total Hip Arthroplasty Using a Direct Lateral Approach. Arch Bone Jt Surg. 2020 Jan;8(1):83-88. doi: 10.22038/abjs.2019.38549.2020. PMID: 32090150; PMCID: PMC7007721

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