Dega transiliac osteotomy in the treatment of advanced forms of Perthes' disease: a literature review

Abstract

The work aims to revise the current views on the effectiveness of Dega's pelvic osteotomy in preventing femoral head deformity in the course of Perthes' disease in patients with late symptoms >8 years of age and withsignificant changes in the radiographic image (Catterall III/IV or Herring B, B/C, C). We did a literature review. Four articles from six found in 'PubMed' which combine Dega acetabuloplasty and Perthes' disease words were fully read and analyzed. Kamegaya (2018), with a 9.5-year follow-up period, described differences comparing the group treated with femoral varus osteotomy with the group that was treated with a combined Dega acetabuloplasty and femoral varus osteotomy. A series of papers by Napiontek from 2004, with an average 8-year follow-up, also describes satisfactory results after Dega's osteotomy, with 27 hips in groups I/II according to Stulberg. Another paper in the series, which analyzed operatively and non-operatively treated patients, shows no differences in the period of time of Perthes disease treatment between the analyzed groups. The last paper in the series from 2001, describes 10 patients treated primarily due to hip dysplasia, who was diagnosed with Perthes disease. Five of them underwent Dega acetabuloplasty obtaining a Stulberg score of I/II in the long-term follow-up. We think it seems reasonable to return to the treatment planning of Perthes' disease using Dega acetabuloplasty as a method to improve the hip congruence in late-diagnosed and advanced forms of the disease.