The Journal of Bone and Joint Surgery, Vol 71, Issue 9 1386-1392, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Rotational osteotomy for proximal femoral focal deficiency
DA Friscia, CF Moseley and WL Oppenheim
Division of Orthopaedic Surgery, University of California, Los Angeles Medical Center 90024.
Thirteen patients who had a proximal femoral focal deficiency and were
treated with a rotational osteotomy of the tibia (Van Nes procedure) were
evaluated at an average of five years after operation. Five patients needed
a repeat osteotomy of the tibia: four because the limb had spontaneously
derotated toward the original position and one because the limb had had
insufficient rotation at the time of operation. One patient had a
disarticulation at the ankle after the first stage of a planned two-stage
procedure because the mother was not happy with the child's appearance. In
ten limbs, the distal femoral growth plate and epiphysis were removed and
in two, the femoral epiphysis and growth plate and the tibial growth plate
were removed so that the joint of the prosthetic knee would be positioned
at the proper height at the completion of the child's growth. Neither
growth plate was removed from one limb, the shorter one in the child who
had bilateral involvement. A ten-point grading scale based on use and fit
of the prosthesis, gait, range of motion of the ankle, use of external
support, and final height of the ankle compared with that of the
contralateral knee was used to evaluate the result, which was excellent in
six patients, good in four, fair in one, and poor in one. One patient, who
had a disarticulation at the ankle, was excluded from the final evaluation.
Rotational osteotomy provided good function and acceptable cosmetic
appearance in the patients who had unilateral involvement.
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