Abstract
Legg-Calvé-Perthes disease is an idiopathic avascular necrosis of the femoral head. Although many surgical approaches to treat the late presentation of this pathology have been proposed, there are few reports about the early results of the double osteotomy procedure (femoral varus osteotomy combined with Salter innominate osteotomy). The purpose of this study was to describe the early results obtained with the double osteotomy in patients with late presentation of Legg-Calvé-Perthes disease. Cross-sectional evaluation of ten patients intervened with double osteotomy. There were seven males and three females with a mean age of 9.2 +/- 1.7 years [standard deviation (SD)]. The average post-surgical time of evaluation was of 46.5 +/- 26.2 months. Of the ten evaluated patients, four had a Catterall III and six had a Catterall IV disease. According to Herring classification, three patients were Herring B and seven were Herring C. The epiphyseal extrusion average before and after the surgical procedure was 19.3 +/- 12.4 and 12.1 +/- 14.9%, respectively. In accordance with the Ratliff classification and Lloyd Roberts radiological results, the following were the postoperative clinical results: four good, five fair and one poor. Based on the Stulberg classification, there was one patient in class I, five in class II, three in class III and one in class IV. The surgical treatment for late Perthes disease with the best expected outcome is still a challenge. According to the resultsreported here, the double osteotomy could be considered as an alternative to treat this entity.
Highlights
The Legg-Calve-Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head, affecting children in its vast majority, especially males in a ratio of three to five males to one female [1]
According to the obtained results from this study, double osteotomy could be considered as an alternative for treatment of patients with late presentation LCPD in which femoral osteotomy or Salter osteotomy alone could have not change the natural course of the disease
The vast majority of articles related to LCPD mention that age and femoral head involvement play an important role in the outcome after treatment [1, 7, 9, 16, 17]
Summary
The Legg-Calve-Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head, affecting children in its vast majority, especially males in a ratio of three to five males to one female [1]. There are multiple approaches to the treatment of LCPD ranging from conservative management to a wide variety of non-surgical and surgical methods. All of these provide the contention of the hip within the acetabular space, in the hope that during the healing phase, the femoral head can become more spherical and with more articular congruence in this position [1]. Among the different surgical approaches that are supported by studies in the orthopedic literature, there is not a specific guideline for the treatment of late presentation LCPD.
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