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Femoral varus de-rotation osteotomy is by far the most frequently performed operation to achieve containment in LCPD. Moderate varus angulation of 20 grade and 20 or 30 grade of external rotation of the distal fragment is sufficient to achieve satisfactory containment . The osteotomy may be either at the intertrochanteric or subtrochanteric level and the femur can be fixed with any one of the commonly available implants (DCP plate, blade plate, proximal locking plate). An open wedge osteotomy will minimize the extent of shortening caused by the varus angulation . The potential disadvantages of performing a proximal femoral varus osteotomy with an opening wedge technique include delay in union of the osteotomy, permanent shortening of the limb and compensatory angular deformity at the knee. However, these complications are not commonly seen in practice. The open wedge does not compromise healing of the osteotomy; delayed union is virtually never seen even in older children . The shortening decreases as the child grows and at skeletal maturity the limb length inequality is inconsequential; usually it is around 0.5 cm . Though genu valgum may develop in some other situations where there is coxa vara, genu valgum was not observed in children with LCPD who had undergone varus osteotomy of the femur . One of the prerequisites for surgical containment is restoration of the range of motion of the hip. In some children limitation of internal rotation of the hip may persist for some time. In these children, a femoral varus extension osteotomy should be done rather than a varus de-rotation osteotomy. Acetabular realignment with improved containment of the femoral head can be achieved by a Salter osteotomy ,triple pelvic osteotomy or peri acetabular osteotomy (first described by GANZ) . Augmenting the acetabulum with a shelf is also an effective way of achieving containment .The results of containment by operating on the acetabulum is as effective as containment by a femoral osteotomy. Some surgeons have advocated combining femoral osteotomy with an acetabular operation anticipating better results than if surgery was done on either the femur or the pelvis alone. However, there isn’t sufficient evidence to support such an approach. Irrespective of the method of containment employed, it must be achieved by Stage 2a of the disease if it is to be effective in preventing deformation of the femoral head .