Outcome of Varus De-rotational osteotomy in patients of perthes disease.

Abstract

Objective: To evaluate the clinical and radiological outcomes of Varus De-rotational Osteotomy (VDRO) in children with unilateral Perthes disease using the Harris Hip Score (HHS), Mose's Index, and Stulberg Classification. Study Design: A prospective, observational, cohort study. Setting: The Orthopaedics Department of Jinnah Postgraduate Medical Center, Karachi, Pakistan. Period: October 2024 and August 2025. Methods: A total of 21 children of either gender, aged 5–12 years, having unilateral Perthes disease and planned to undergoing VDRO were analyzed. Clinical and radiological evlauations were performed. VDRO was performed adopting standard lateral approach with varus and derotation correction under fluoroscopy. Postoperative care involved immobilization, physiotherapy, and follow-up evaluations were made after 6 months. Data were analyzed using SPSS 26.0 with p<0.05 set as significance level. Results: In a total of 21 children, 12 (57.l%) were male, and the overall mean age was 8.24±2.23 years. The right hip was involved in 12 (57.1%) children. At presentation, hip pain was noted in 9 (42.9%), and limp in 5 (23.8%) patients. HHS improved across all stages, highest in Stage III (61.25→88.75). Outcome distribution included 28.6% excellent, 23.8% good, 33.3% fair, and 14.3% poor, with no significant association with stage (p=0.285). Pain improved in 17 (81.0%), limp resolved in 13 (61.9%), and abduction improved in 11 (52.4%) patients. Postoperative complications included infection in 9 (42.9%), non-union in 6 (28.6%), and limb length discrepancy in 5 (23.8%) patients. Conclusion: VDRO is an effective surgical option for improving clinical and radiological outcomes in Perthes disease, though postoperative complications remain a concern.