Combined salter innominate osteotomy with femoral shortening versus other methods of treatment for Legg-Calvé-Perthes disease.

The results of treatment of Legg-Calvé-Perthes disease in 357 patients at the Institute for Orthopaedic Surgery "Banjica," Belgrade, from January 1963 to December 1987 with > or = 10 years of follow-up are summarized. The advantages of combined Salter innominate osteotomy with femoral shortening, as a one-step operation, are emphasized. Male predominance was found in a ratio of 4.75:1, and bilateral involvement was present in 21% of the patients. Disease onset was usually between ages 4 and 7 years (mean 6.5 years). Catterall criteria for the classification of the disease were used; patients in groups I and II were treated nonsurgically and those in groups III and IV were treated surgically. Most of the surgically treated patients (64.4%) had one or more head risk factors. The most frequently used surgical procedure was a Salter innominate osteotomy with or without femoral shortening. Assessment of treatment was made by measuring the final center-edge angle and by using criteria developed by Catterall, Mose, Harrison, and Stulberg. Final functional status of the operated hips was recorded as well. The greatest final center-edge angle of 34.27 degrees was found in the patients treated with combined Salter innominate osteotomy and femoral shortening, showing improvement of 14.98 degrees. Surgical treatment, except for revascularization procedures, showed good and fair results in > 90% of patients. The range of hip motion was improved in most patients. The earliest weight-bearing allowance was found in patients who underwent Salter innominate osteotomy and femoral shortening; it averaged 3.1 months. The duration of immobilization was also the shortest in this group. The average femoral shortening was 1.38 cm (range 0.9-1.9 cm). The proposed combined Salter osteotomy with femoral shortening is recommended for the treatment of more severe cases of Legg-Calvé-Perthes disease, thus preventing establishment of early secondary hip arthrosis.