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Table 4 Characteristics and outcomes of studies on combined FHRO + PAO in the literature

From: Simultaneous femoral head reduction osteotomy (FHRO) combined with periacetabular osteotomy (PAO) for the treatment of severe femoral head asphericity in Perthes disease

Study and reference

Year

Hips

Sex (boy)

Mean age (years)

Follow-up (year)

Open physis (%)

PAO

Previous hip surgery

Radiologic outcomes (before to after surgery)

Stulberg classification

Function

Hip ROM

Complications

Ganz et al

2011

14 (8 FHRO + PAO)

NR

NR

 > 3 years

NR

PAO (n = 8)

NR

NR

NR

The motion was improved without significant pain for all patients

NR

Subsequent surgical procedures (n = 4): varus intertrochanteric osteotomy (n = 1) and PAOs (n = 3)

Siebenrock et al

2015

11 (4 had PAO + FHRO)

7 (64%)

13

5

1 (9.1%)

Triple (n = 2)

PAO (n = 2)

Varus intertrochanteric osteotomy (n = 1)

Head sphericity:72 to 85%

Extrusion index: 47 to 20%

LCEA: 1 to 26°

Shenton’s line: All intact (100%)

Acetabular index: 17 to 7°

Centrum–collum–diaphyseal angle: 133 to 139°

Axial alpha angle: 40 to 42°

Before:

V (n = 2)

IV (n = 2)

After:

II (n = 5)

III (n = 4)

IV (n = 1)

Merle d’Aubigne´-Postel score: 14.5 to 15.7

Flexion: 94 to 91

Internal rotation: 13 to 15

External rotation: 28 to 23

Subsequent surgical procedures (n = 7): hardware removal (n = 2) and containment surgery (n = 5)

Heterotopic ossification Brooker Grade II (n = 1)

Clohisy et al

2018

6 (5 with LCPD)

0

13.6

3.3

NR

n = 4

NR

LCEA: 2.5° to 30.6°

ACEA: 18. 2° to 35.2°

Tönnis: 20.1° to 2.5°

Extrusion index: 45.3 to 13.6%

α angle (Dunn view): 68.5 to 40.2°

α angle (frog lateral view): 65.7 to 32.7°

Before:

IV (n = 6)

HHS: 53.5 to 83.4

WOMAC: 62.3 to 90.3

NR

wound infection (n = 1)

Present study

2022

4

4 (100%)

10

5

4 (100%)

Triple (n = 2)

Ganz (n = 2)

Abductor tenotomy (n = 1)

LCEA: 2.8° to 32°

ACEA: 13.8 to 30°

Tönnis: 18° to 8°

Sphericity index: 83.3 to 95%

Extrusion index: 39.8 to 7%

Shenton’s line: All non-disrupted

Before:

V (n = 2)

IV (n = 2)

After:

II (n = 3)

III (n = 1)

HHS: 69 to 96.3

Merle d’Aubigne´-Postel score: 12.3 to 18

Total: 222.5° to 267.5°

Flexion: 122.5 to 122.5

Abduction: 26.3 to 38.8

Adduction: 17.5 to 30

Internal rotation: 13.8 to 31.3

External rotation: 42.5 to 45

Heterotopic ossification (n = 3 grade II and n = 1 grade I)

  1. FHRO Femoral head reduction osteotomy, PAO Periacetabular Osteotomy, HHS Harris hip score, NR not reported