Periosteal stripping and periosteal division for leg length discrepancy after proximal femoral intertrochanteric osteotomy for Perthes disease

Abstract Background: Periosteal stripping and periosteal division (PSPD) promotes growth of the long bone of children with leg length discrepancy (LLD). We performed PSPD when LLD was observed at the time of implant removal surgery after proximal femoral osteotomy for Perthes disease. This study aimed to clarify the efficacy and safety of PSPD for acquired LLD related to Perthes disease. Methods : This retrospective study enrolled 10 patients treated with PSPD and 6 control patients who declined the PSPD for LLD associated with Perthes disease. The lengths of the femur, tibia and entire leg were measured in the full-length standing radiographs at baseline and final follow-up. Baseline was defined as the time of the last preoperative observation. LLD and changes in LLD (ΔLLD) were measured. The correlation of ΔLLD with age at time of surgery, follow-up period, and extent of PSPD was investigated. Results : Patients’ mean age and LLD at baseline were 9.4 years and 20.5 ± 4.6 mm in the PSPD group and 10.2 years and 11.5 ± 10.0 mm in the control group. With a mean follow-up period of 4.3 years, the PSPD group showed a mean ΔLLD decrease of 13.9 mm, which was significantly greater than that of the control group at 3.2 mm with a mean follow-up period of 5.4 years. Logistic regression analysis revealed that age at the time of surgery was a significant factor for obtaining >10 mm ΔLLD with PSPD and the cutoff value by the receiver operating characteristic curve was 9.6 years (sensitivity, 0.83; specificity 0.83). Conclusion : PSPD seemed to be a safe and effective surgical option for LLD associated with Perthes disease. The age at the time of surgery negatively correlated with the amount of LLD correction. Obtaining >10 mm LLD correction is more likely if the patients are <10 years of age. Trial Registration: Present study was registered in original registration system in Chiba Children’s Hospital. Registration number was 2021-074 and registration date was 14 th May 2022.