Combined Surgical Dislocations and Proximal Femoral Osteotomies for Treatment of Complex Proximal Femoral Deformities: A Systematic Review

Background: Complex proximal femoral deformities such as slipped capital femoral epiphyses (SCFE) or residual Perthes disease pose challenging clinical problems due to the severity of pathological femoral head and neck changes from long-standing childhood disease. Utilizing the combination of surgical dislocation (SD) and proximal femoral osteotomy (PFO) is an option to address both the intra-articular pathologies as well as the maximal correction of the proximal femoral deformities. The purpose of this systematic review was to report clinical and radiographical outcomes for patients undergoing these combined procedures. Methods: A systematic review of the literature was performed utilizing PRISMA guidelines. Databases queried were PubMed, OVID Medline, Embase, SCOPUS, Cochrane Central Register of Clinical Trials, and clinicaltrials.gov from their dates of inception to 7/03/2024. Studies were included if they reported outcomes for patients undergoing combined SDs and PFOs. Each study's data was manually retrieved from the full-text manuscript. The study design, surgical technique, indications, demographic and radiographic data, outcomes, and complications of each study were analyzed. Results: There were six case series (Evidence Level IV) included in this review. There were 132 patients (46% female) with mean age of 16.5 years (range: 9-30). Etiologies were most commonly SCFE (50.8%) and Perthes (31.8%). Mean follow-up was 40.1 months (range: 3-127). The mHHS improved from 61.9±4.5 to 84.8±6.7. Complication rates were low at 11.4% with the most common complication being instrumentation failure (20%). Lateral slip angles improved from 58.5°±6.5° to 14.4 ±3.6° in 42 patients who underwent combined SD/PFO for SCFE. Alpha angles improved from 86.7°±6.7° to 50.9°±4.8°. Articular-trochanteric distance improved from 0.7±4.5mm to 23.4±3.1mm. Conclusion: Combined SDs and PFO's should be considered a safe and effective treatment option for patients with severe femoral head and neck pathologies which were more likely from long-standing childhood diseases instead of severe deformities in the setting of SCFE or residual Perthes. This review demonstrated positive radiographic and clinical outcomes when these patients are treated, as well as a low complication and AVN rate. Further research should continue to study the combined approach in larger cohorts and at longer-term follow-up. Level of Evidence: IV.