A combined treatment strategy of Legg-Calve-Perthes disease with BEST quartet.

Abstract

Abstract Purpose: The main pathology of Legg-Calvé-Perthes Disease (LCPD) is the disruption of blood flow of the femoral head resulting ischemic necrosis which leads hip joint incongruency. The most frequent methods in the treatment are the methods improving the containment of the femoral head. Our study aimed to investigate the mid-long-term outcomes of LCPD patients treated with the BEST method, which aims to improve congruency and containment simultaneously. Materials and methods: LCPD patients who were treated with (B)leeding the epiphysis by drilling, (E)vacuation of the joint synovitis, contained with (S)alter’s Osteotomy, and distracted with skin (T)raction investigated retrospectively. Only patients who reached skeletal maturity were included in the study. Patients’ final radiographs were classified according to the Stulberg classification, Mose classification, and Tönnis osteoarthritis classification. Results: The mean follow-up of the patients was 10.44±1.35 (8.5-13) years, and the mean age at the last follow-up was 17.71±1.73 (15.25-20.83) years. According to the Stulberg classification, 11 (45.8%) of the patients had a Class-I hip; 6 (25%) a Class-II hips; 3 (12.5%) a class-III hips, 4 (16.7%) a class-IV hips. According to the Mose classification, 12 (50%) of the patients had good results; 5 (20.8%) had fair results; 7 (29.1%) had poor results. Conclusion: In conclusion BEST treatment method for LCPD is a combined procedure which addresses to all pathologies of disease at the same time. This combined treatment protocol may be preferred for severely affected LCPD cases who with subluxation especially in higher lateral pillar class that are prone to nonspherical incongruency.