Pathophysiology and surgical approaches to the treatment of children with post-ischemic femoral head deformity: a literature review

Background. Postischemic deformations of the femoral head resulting from Legg-Calve-Perthes disease and avascular necrosis of the femoral head in children lead to disturbances in the anatomy and function of the hip joint and its early arthrosis. The issues of choosing treatment methods and timing of operations remain relevant at present.

Aim. Conduct an analytical review of domestic and foreign scientific publications devoted to issues of surgical treatment of children with post-ischemic deformities of the femoral head, with the aim of systematizing existing surgical methods, assessing their effectiveness and identifying promising areas for the development of this section in pediatric orthopedics.

Materials and methods. The article presents the results of a search in the PubMed, Cochrane and eLIBRARY databases. Of the 64 sources (28 in Russian, 36 in English for 2000–2023), 48 are devoted to the surgical treatment of these deformities.

Results. Extra-articular operations show effective medium-term results in correction of post-ischemic deformations but can cause complications such as premature closure of the epiphysis growth zone and greater trochanter, leading to deterioration of the congruence of the articular surfaces. Intra-articular interventions using surgical hip dislocation have become widespread in recent years, allowing for visualization of the structure and shape of the femoral head during surgery, which determines its most rational restoration.

Conclusions. The conducted study showed that gradual development of multiplanar deformations of the femoral head in various nosological forms of hip joint diseases in children leads to persistent loss of joint function and early disability of patients with untimely or inadequate treatment. Analysis of scientific literature data indicates that intra-articular interventions can be quite effective in the treatment of children with post-ischemic deformations of the femoral head. However, for a more objective assessment of their impact on the further development of the disease, a more in-depth study of the dynamics of the femoral head formation and an analysis of long-term treatment results are required.