Surgical Approaches to the Treatment of Children With Postischemic Deformities of the Femoral Head: A Review

Postischemic deformities of the femoral head resulting from Legg–Calvé–Perthes disease and avascular necrosis of the femoral head in children cause disruption of hip joint anatomy and function and early osteoarthritis. The choice of treatment and surgical timing remains a relevant clinical issue. This study reviewed Russian and international publications on surgical treatment of children with postischemic deformities of the femoral head, with the aim of systematizing current surgical techniques and evaluating their effectiveness and identifying promising directions for pediatric orthopedics. The search was conducted in PubMed, Cochrane Library, and eLibrary. Among 64 sources found (28 in Russian and 36 in English, published between 2000 and 2023), 48 focused on the surgical treatment of these deformities. Extra-articular procedures induce effective mid-term outcomes in correcting postischemic deformities, but may cause complications such as premature epiphyseal and greater trochanter growth plate closure, which impair joint congruency. In recent years, intra-articular procedures involving surgical hip dislocation have become widespread. This method provides the opportunity to directly assess the condition, shape, and structure of the femoral head during the intervention, allowing for the most effective restoration of its anatomy. The present study shows that gradual progression of multiplanar femoral head deformities in various hip disorders in children leads to persistent dysfunction and early disability if treatment is delayed or inadequate. Analysis of scientific data revealed that intra-articular interventions may be effective in the treatment of patients with postischemic femoral head deformities. However, a more objective evaluation of their impact on the further course of the disease requires an analysis of long-term treatment outcomes.