Asymmetrically increased femoral version with high prevalence of moderate and severe femoral anteversion in unilateral Legg-Calvé-Perthes disease

Abstract

Purpose To determine and stratify femoral version in Legg-Calvé-Perthes disease (LCPD), and to compare the femoral version between the LCPD hip and the contralateral unaffected hip. Methods We performed a retrospective review of 45 patients with unilateral LCPD who had available CT scan through the hips and knees between January 2000 and June 2017. There were 34 (76%) male cases with a mean age of 14 years (sd 4.69). Two independent readers measured femoral version on the affected and the unaffected contralateral femur. Femoral version was classified as follows: severely decreased version (< 10°); moderately decreased (10° to 14°); normal femoral version range (15° to 20°); moderately increased (21° to 25°); and severely increased version (> 25°). Results LCPD hips had predominantly increased femoral version (38% severely increased anteversion, 24% moderately increased anteversion), while 51% of the contralateral unaffected hips had normal femoral version (p < 0.001). LCPD hips had higher mean femoral version than the contralateral, unaffected side (mean difference = 13o; 95% confidence iterval 10o to 16o; p < 0.001). As the version of the affected hip increased, so did the discrepancy between sides. No effect of sex on the LCPD femoral version was detected (p = 0.34). Conclusion This study included a selected group of patients with unilateral LCPD and available CT scans obtained for surgical planning. The femoral version was asymmetric, with a high proportion of excessive anteversion observed at later stages of disease in the affected hips. Future studies will be necessary to determine the pathogenesis of increased femoral version associated with LCPD. Level of Evidence Level IV, retrospective study.

Treatment of Symptomatic Residual Deformity in Legg-Calvé-Perthes Disease

“…Our study had several limitations. First, in nearly one-third of the patients, we performed an intertrochanteric osteotomy to improve the concentricity of the joint and to rotate the femur when deviation from normal torsion was present 33 . Although the additional osteotomy may have impacted the surgical outcome, the proportion of patients who received a femoral osteotomy was similar (p > 0.99) between those with surgical failure (25%) and with preserved hips (29%).…”

Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg–Calvé–Perthes disease

“…Instead, the addition of derotation and/or extension maneuver may be a promising adjunct to pelvic osteotomy partly because a high proportion of excessive anteversion, which can lead to decreased acetabular coverage, was observed at later stages of the disease in the affected hips. 19 Given the previous knowledge that less varus angulation was associated with a greater probability of obtaining a Stulberg grade I or II outcome for the LP-B hips, 20 careful considerations may be required to determine whether varus correction should be added to the osteotomy. Gradual correction of the asymmetric growth of the physis seems to be an alternative approach to obtaining a more spherical femoral head in selected patients.…”