{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:25:11Z","timestamp":1790684711178,"version":"4.1.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Proximal femoral varus osteotomy (PFVO) is a common procedure performed in children with developmental dysplasia of the hip (DDH) and Legg\u2013Calv\u00e9\u2013Perthes disease (LCPD). However, the long-term effect on angular deformities of the knees and ankles following PFVO remains controversial. This study investigated the relationship between PFVO and alignment changes in the knee and ankle after the procedure. Twenty-five patients undergoing PFVO procedure with a minimum 4-year evaluation period were enrolled in the study, including 14 unilateral LCPD and 11 unilateral DDH. The standing scanogram examinations were collected before the operation, immediately following surgery, after a 1-year follow-up, after a 3-year follow-up, and at the final visit to the clinic. The radiographic parameters included leg length, femoral neck-shaft angle (FNSA), femorotibial angle (FTA), mechanical axis deviation (MAD), tibiotalar angle (TTA), and mechanical lateral distal femoral angle (mLDFA). At the final examination, FNSA demonstrated insignificant change between the operative and non-operative limbs in the DDH group. Compared with the postoperative result, FNSA significantly improved in the LCPD group (<jats:italic>p<\/jats:italic> = 0.039). Both groups did not develop statistical significance in TTA, mLDFA, MAD, and leg length discrepancy after more than a 5-year follow-up. From a biomechanical perspective that the foot passes more medial to the knee under the center of leg mass, varus knee was prone to develop. In order to correct the mechanical axis, the knee reverted to a valgus position gradually. Our study indicates that patients with LCPD or DDH receiving PFVO and Pemberton osteotomy narrow the gap of angular growth in knees and ankles between the operative and non-operative limbs after a long-term follow-up.<\/jats:p>","DOI":"10.3389\/fped.2022.835447","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T05:25:05Z","timestamp":1649222705000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["A Long-Term Study of Alignment Correction Following Proximal Femoral Varus Osteotomy and Pemberton Osteotomy in Children With Legg\u2013Calv\u00e9\u2013Perthes Disease and Developmental Dysplasia of the Hip"],"prefix":"10.3389","volume":"10","author":[{"given":"Kuei-Yu","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan-Wen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Che","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Chieh","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken N.","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Feng","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-Ming","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-642-66212-6","author":"Pauwels","year":"1976","journal-title":"Biomechanics of the Normal and Diseased Hip: Theoretical Foundation, Technique and Results of Treatment An Atlas."},{"key":"B2","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1097\/BPO.0000000000000840","article-title":"Single versus combined procedures for severely involved legg-calv\u00e9-perthes disease.","volume":"38","author":"Kamegaya","year":"2018","journal-title":"J Pediatr Orthop."},{"key":"B3","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1097\/01241398-199901000-00017","article-title":"Femoral varus osteotomy in legg-calv\u00e9-perthes disease: points at operation to prevent residual problems.","volume":"19","author":"Kitakoji","year":"1999","journal-title":"J Pediatr Orthop."},{"key":"B4","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1302\/0301-620x.77b5.7559705","article-title":"Varus derotation osteotomy for persistent dysplasia in congenital dislocation of the hip. proximal femoral growth and alignment changes in the leg.","volume":"77","author":"Suda","year":"1995","journal-title":"J Bone Joint Surg Br."},{"key":"B5","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1302\/0301-620X.62B4.7430219","article-title":"A controlled study of the results of femoral osteotomy in severe Perthes\u2019 disease.","author":"Canario","year":"1980","journal-title":"J Bone Joint Surg Br."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1016\/S0140-6736(07)60710-7","article-title":"Developmental dysplasia of the hip.","volume":"369","author":"Dezateux","year":"2007","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"448","DOI":"10.2106\/00004623-199403000-00017","article-title":"The treatment of legg-calv\u00e9-perthes disease. a critical review of the literature.","volume":"76","author":"Herring","year":"1994","journal-title":"J Bone Joint Surg Am."},{"key":"B8","doi-asserted-by":"publisher","first-page":"961","DOI":"10.2106\/00004623-198466060-00021","article-title":"The present status of surgical treatment for legg-perthes disease.","volume":"66","author":"Salter","year":"1984","journal-title":"J Bone Joint Surg Am."},{"key":"B9","doi-asserted-by":"publisher","first-page":"401","DOI":"10.5435\/00124635-200111000-00005","article-title":"Developmental dysplasia of the hip from six months to four years of age.","volume":"9","author":"Vitale","year":"2001","journal-title":"J Am Acad Orthop Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.1007\/s11999-009-0727-8","article-title":"Genu valgum in legg-calv\u00e9-perthes disease treated with femoral varus osteotomy.","volume":"467","author":"Glard","year":"2009","journal-title":"Clin Orthop Relat Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s11832-013-0487-6","article-title":"Does proximal femoral varus osteotomy in legg-calv\u00e9-perthes disease predispose to angular mal-alignment of the knee? A clinical and radiographic study at skeletal maturity.","volume":"7","author":"Tercier","year":"2013","journal-title":"J Child Orthop."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1148\/128.1.1","article-title":"The adult hip: an anatomic study. Part I: the bony landmarks.","volume":"128","author":"Armbuster","year":"1978","journal-title":"Radiology."},{"key":"B13","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-642-59373-4","author":"Paley","year":"2002","journal-title":"Principles of Deformity Correction."},{"key":"B14","first-page":"48","article-title":"Mechanical axis deviation of the lower limbs. preoperative planning of uniapical angular deformities of the tibia or femur.","volume":"280","author":"Paley","year":"1992","journal-title":"Clin Orthop Relat Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1002\/art.22515","article-title":"Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee.","volume":"56","author":"Brouwer","year":"2007","journal-title":"Arthritis Rheum."},{"key":"B16","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1177\/107110070502600909","article-title":"The surgical tibiotalar angle: a radiologic study.","volume":"26","author":"Knupp","year":"2005","journal-title":"Foot Ankle Int."},{"key":"B17","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1097\/01.bpo.0000173244.74065.e4","article-title":"Quantitative segmental analysis of weight-bearing radiographs of the foot and ankle for children: normal alignment.","volume":"25","author":"Davids","year":"2005","journal-title":"J Pediatr Orthop."},{"key":"B18","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1097\/00004694-200411000-00012","article-title":"Remodeling of the proximal femur after upper femoral varus osteotomy for the treatment of legg-calv\u00e9-perthes disease.","volume":"24","author":"Herceg","year":"2004","journal-title":"J Pediatr Orthop."},{"key":"B19","first-page":"248","article-title":"Neck-shaft angle remodelling after derotation varus osteotomy for severe perthes disease.","volume":"67","author":"Talkhani","year":"2001","journal-title":"Acta Orthop Belg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1097\/BPO.0b013e31818456dc","article-title":"To what extent does remodeling of the proximal femur and the acetabulum occur between disease healing and skeletal maturity in Perthes disease? A radiological study.","volume":"28","author":"Shah","year":"2008","journal-title":"J Pediatr Orthop."},{"key":"B21","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s12306-007-0003-6","article-title":"Remodelling and overgrowth after conservative treatment for femoral and tibial shaft fractures in children.","volume":"91","author":"Stilli","year":"2008","journal-title":"Chir Organi Mov."},{"key":"B22","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1302\/0301-620X.74B5.1527131","article-title":"Remodelling of angular deformity after femoral shaft fractures in children.","volume":"74","author":"Wallace","year":"1992","journal-title":"J Bone Joint Surg Br."},{"key":"B23","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-642-71031-5","author":"Wolff","year":"1986","journal-title":"The Law of Bone Remodelling."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.835447\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T05:25:11Z","timestamp":1649222711000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.835447\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,6]]},"references-count":23,"alternative-id":["10.3389\/fped.2022.835447"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.835447","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,6]]},"article-number":"835447"}}