Greater trochanteric epiphysiodesis

Abstract

In this paper, we wished to determine: (1) if a greater trochanteric epiphysiodesis (GTE) slows the growth of the greater trochanter; (2) if bone peg epiphysiodesis or screw epiphysiodesis is more effective at slowing greater trochanteric growth; and (3) if a GTE is most effective in young (<8 years) or older (>8) age. In this retrospective study, 35 children with unilateral Perthes disease underwent GTE. The height of the greater trochanter was measured radiographically at the time of surgery and at least two years after surgery. The untreated opposite side, which showed no radiographic evidence of Perthes disease, was used as a control. Epiphysiodesis was performed by using multiple drill holes and either a screw or a bone peg. Mean age at the time of surgery was 7 years (range, 3.2 to 12.2 years) and mean follow-up was 58 months (range, 24 to 104 months). We found that the growth of the greater trochanter that underwent epiphysiodesis was inhibited by 0.9 mm/year, as compared to the unaffected side (p=0.007). Greater inhibition (1.8 mm/year) was noted in children who underwent a bone peg epiphysiodesis and also, surprisingly, in those over 8 years of age.

Figures

Fig. 1

Radiographic measurements of the articulotrochanteric distance (ATD), trochanter-to-trochanter distance (TTD) and lesser trochanter-to-articular surface distance (LTA)

Fig. 2

Scatter plot of the ATD, TTD and LTA measurements versus age for the unaffected hip