Clinical Outcome of Femoral Osteotomy in Patients with Legg-Calve´-Perthes Disease

Document Type : RESEARCH PAPER

Authors

Orthopedic Research Center, Ghaem Hospital Mashhad University of Medical Sciences Ahmad-Abad Street, Mashhad, 91799-9199 Iran.

Abstract

 
Background: Legg-Calve´-Perthes disease is a juvenile idiopathic osteonecrosis in which the blood supply of femoral head
is not sufficient and the bone dies provisionally. The aim of this study is to evaluate outcome of Femoral osteotomy in children with LCPD in our University Hospital.
 
Methods:
In a descriptive analytic study, between 2008 and 2013, patients with the diagnosis of Legg-Calve’-Perthes confirmed with lateral pillar calcification of B and B/C border were entered and patients were encouraged to come to an outpatient clinic for follow-up. Descriptive analysis of the demographics was performed and relation between variables was tested using a two-sided Student’s t test with statistical significance set at (p=0.05).
Results:
Mean age of patients was 9±1.3 years, with the range of 4 to 12 years old. 25 patients (86.2%) were male and 4 patients (13.4%) female. There was no positive family history in patients. 17 patients (58.6%) had history of trauma. Duration of symptom presentation was 7±6.3 months, with the range of 3 to 36 months. In 20 of patients (69%) left hip and in 12 (41.4%) right hip was involved. There was significant relation between femoral head asymmetry, trochanter enlargement (P=0.04), acetabolum changes (P<0.000), femoral neck shortening (P<0.000). There was no relation between age (P=0.28) and duration of disease (P=0.8) with femoral neck shortening.
Conclusion:
Intrtrochantric Osteotomy led to improvement in pain, limping and increase range of motion. Subluxation before surgery is one of the criteria, which could influence further prognosis. Acetabulom changes and femoral neck shortening are two factor seriously effect hip ROM.

Keywords


  1. Millis MB, Lewis CL, Schoenecker PL, Clohisy JC. Legg-Calvé-Perthes disease and slipped capital femoral epiphysis: major developmental causes of femoroacetabular impingement. J Am Acad Orthop Surg. 2013; 21:59-63.

  2. Tannast M, Macintyre N, Steppacher SD, Hosalkar HS, Ganz R, Siebenrock KA. A systematic approach to analyse the sequelae of LCPD. Hip Int. 2013; 23:61-70.

  3. Novais EN. Application of the surgical dislocation approach to residual hip deformity secondary to Legg-Calvé-Perthes disease. J Pediatr Orthop. 2013;33:62-9.

  4. Park KW, Jang KS, Song HR. Can residual leg shortening be predicted in patients with legg-calvé-perthes’ disease? Clin Orthop Relat Res. 2013;471:2570-7.

  5. Javid M, Wedge JH. Radiographic Rsults of Combined Salter Innominate and Femoral Osteotomy in Legg–Calvé–Perthes Disease in Older Children. IJOS. 2012; 10:106-13.

  6. Eamsobhana P, Kaewpornsawan K. Combined osteotomy in patients with severe Legg-Calve-Perthes disease. J Med Assoc Thai. 2012;95:128-34.

  7. Moya-Angeler J, Abril JC, Rodriguez IV. Legg-Calvé-Perthes disease: role of isolated adductor tenotomy? Eur J Orthop Surg Traumatol. 2013; 23:921-5.

  8. Thompson GH, Choi IH. Legg-Calve-Perthes disease centenary. J Pediatr Orthop. 2011;31:129.

  9. Costa CR, Johnson AJ, Naziri Q, Mont MA. Review of total hip resurfacing and total hip arthroplasty in young patients who had Legg-Calvé-Perthes disease. Orthop Clin North Am. 2011;42:419-22.

  10. Joseph B, Price CT. Principles of containment treatment aimed at preventing femoral head deformation in Perthes disease. Orthop Clin North Am. 2011; 42:317-27.

  11. Neyt JG, Weinstein SL, Spratt KF, Dolan L, Morcuende J, Dietz FR, et al. Stulberg classification system for evaluation of Legg-Calvé-Perthes disease: intra-rater and inter-rater reliability. J Bone Joint Surg Am. 1999; 81:1209-16.

  12. Wagenaar FB, Maathuis CG, van Erve RH. Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment. J Child Orthop. 2011;5:89-95.

  13. Hailer YD, Montgomery S, Ekbom A, Nilsson O, Bahmanyar S. Legg-Calvé-Perthes disease and the risk of injuries requiring hospitalization: a register study involving 2579 patients. Acta Orthop. 2012;83:572-6.

  14. Loder RT, Browne RH, Millis A, Kim WC, Shah H, Cosgrove AP, et al. The time of the insult/triggering event in Legg-Calvé-Perthes’ disease determined by incubation period modeling and the age distribution of children with Perthes’. Iowa Orthop J. 2012;32:69-75.

  15. Perry DC, Bruce CE, Pope D, Dangerfield P, Platt MJ, Hall AJ. Legg-Calvé-Perthes disease in the UK: geographic and temporal trends in incidence reflecting differences in degree of deprivation in childhood. Arthritis Rheum. 2012;64:1673-9.

  16. Wiig O, Svenningsen S, Terjesen T. Legg-Calvé-Perthes disease. Tidsskr Nor Laegeforen. 2011;131:946-9.

  17. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. 2004;86:2103-20.

  18. Terjesen T, Wiig O, Svenningsen S. The natural historyof Perthes’ disease: risk factors in 212 patients followed for 5 years. Acta Orthop. 2010; 81:708-14.

  19. Canavese F, Dimeglio A. Perthes disease. Prognosis in children under six years of age. J Bone Joint Surg Br. 2008; 90: 940–5.