Medial percutaneous hemi-epiphysiodesis improves the valgus tilt of the femoral head in developmental dysplasia of the hip (DDH) type-II avascular necrosis

Figures & data

Table 1. Patient characteristics

Patient	Sex	Age	Medial hemi-epiphysodesis age (years)	First operation	Follow-up period years
Study group
1	F	18	7.7	Medial open reduction	11
2	M	15	6.9	Femoral + pelvic osteotomy	7.6
3	F	13	10.2	Femoral + pelvic osteotomy	2.5
4	F	15	6.6	Femoral + pelvic osteotomy	7.9
5	F	12	8.7	Medial open reduction	3.1
6	F	17	9.1	Medial open reduction	8.1
7	F	14	8.3	Medial open reduction	5.5
8	F	13	10.5	Femoral + pelvic osteotomy	2.1
9	F	10	6	Medial open reduction	3.3
Mean		14.1	8.2		5.7
Control group
1	F	12	–	Medial open reduction	8
2	F	13	–	Medial open reduction	10
3	F	9	–	Medial open reduction	2
4	F	13	–	Medial open reduction	9
5	F	12	–	Medial open reduction	9
6	F	11	–	Medial open reduction	9
7	F	13	–	Medial open reduction	11
8	F	11	–	Medial open reduction	11
9	M	13	–	Medial open reduction	10
10	F	9	–	Medial open reduction	4
Mean	11.6	–		8.3

Table 2. Radiological measurements

Patients	Operated hip	CE angle		Epiphyseal inclination angle		Articulotrochanteric distance, mm		Head-shaft angle		Leg length inequality, mm	McKay clinical classification
		Preop.	Postop.	Preop.	Postop.	Preop.	Postop.	Preop.	Postop.
Study group
1	R	10	25	0	18	29	33	150	126	5	Excellent
2	R	18	27	3	13	55	30	150	158	6	Excellent
3	R	25	25	4	11	27	35	160	160	5 (Left)	Excellent
L	35	42	12	32	30	32	150	145	0	Excellent
4	R	32	32	2	29	26	21	152	141	10	Excellent
5	R	19	25	6	6	36	40	153	148	12	Excellent
6	R	11	13	11	32	27	27	152	138	20	Excellent
7	R	24	20	5	13	39	30	146	144	0	Excellent
8	R	22	32	11	9	31	35	157	153	0	Excellent
L	26	28	0	0	29	29	160	148	0	Excellent
9	L	18	22	10	24	31	17	162	152	17	Excellent
Mean		21.8	26.5	5.8	17.0	32.7	29.9	153.8	146.6	8.3
Median		22	25	5	13	30	30	152	148	5
Control group
1	L	25	30	5	12	–	21	–	155	0	Excellent
2	L	6	8	6	11	–	15	–	140	5	Excellent
3	L	10	13	6	10	–	25	–	157	5	Excellent
4	R	18	25	4	10	–	19	–	159	2	Good
5	R	10	16	10	16	–	14	–	138	3	Excellent
L	0	−7	12	14	–	12	–	145	0	Good
6	L	10	10	8	8	–	17	–	151	0	Excellent
7	R	20	35	10	14	–	15	–	135	0	Excellent
L	10	16	6	8	–	17	–	145	0	Excellent
8	L	10	18	10	10	–	12	–	146	2	Excellent
9	R	12	15	5	10	–	26	–	148	0	Excellent
10	R	15	21	9	13	–	23	–	151	0	Excellent
Mean		12.2	16.7	7.6	11.3	–	18.0	–	147.5	1.7
Median		10	16	7	10.5	–	17	–	147	0

Figure 1. Peroperative percutaneous medial hemi-epiphysiodesis technique.

Figure 2. Preoperative epiphyseal and acetabular coverage angles in a bilateral type-II AVN patient.

Figure 3. Postoperative epiphyseal and acetabular coverage angles in the same bilateral type-II AVN patient. There is significant correction on the left side.