PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Alessia Caldaci; Gianluca Testa; Eleonora Dell'Agli; Marco Sapienza; Andrea Vescio; Ludovico Lucenti; Vito Pavone Journal: Children (Basel) Date: 2022-07-27