Intraarticular hip preservation procedures in healed Perthes disease: a systemic review and meta-analysis

Background: Data about surgical options in treatment of healed Perthes disease are limited. The authors conducted this systematic review and meta-analysis to compare two newly described surgical techniques: femoral head reduction osteotomy (FHRO) and relative femoral neck lengthening (RFNL) in the management of healed Perthes disease in terms of efficacy and complications. Methods: This systematic review and meta-analysis examined controlled and noncontrolled studies that compared FHRO and RFNL. The authors searched the Medline database via PubMed, EMBASE, and Cochrane Library for studies published between January 2000 and February 2021. Results: Fourteen studies that assessed RFLN and five studies that assessed FHRO were examined. The FHRO group demonstrated better improvement in the Harris Hip Score (HHS) than RFLN. The RFNL group showed better improvement than the FHRO group regarding flexion and internal rotation degree. The incidence of postoperative pain and postoperative stiffness was higher in the FHRO group than in the RFNL group. In the FHRO group, 28 patients with postoperative complications were reported (59.5%) versus 72 patients in the RFNL (16.4%). Conclusions: FHRO and RNFL are effective and safe modalities for post-Perthes sequelae. However, the postoperative clinical outcomes were observed to be in favor of RFNL, with less incidence of postoperative complications compared to the FHRO. Moreover, the FHRO group needed more secondary acetabular procedures than the RFNL group. On the other hand, FHRO showed greater improvements in radiographic coverage indices.