Do Femoral or Salter Innominate Osteotomies Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease? A Meta-analysis

Abstract

Background Recently, the authors of two prospective multicenter observational studies recommended surgery to improve head sphericity in older children, whereas large retrospective observational studies suggest that surgery does not improve head sphericity in older children. Thus, the treatment for Legg-Calvé-Perthes disease (LCPD) remains controversial. Questions/purposes Using a meta-analysis we asked whether femoral varus osteotomy (FVO) or Salter innominate osteotomy (SIO) resulted in better radiographic head sphericity at the end of the disease process as compared with nonsurgical modalities. Methods We systematically searched the literature using the key concepts LCPD, operative treatment, and nonoperative treatment. Of 160 abstracts, 57 full-text studies were reviewed and 14 papers chosen for meta-analysis. Subgroup analyses were performed to assess the impact of age and stage of disease. The odds of a spherical head after operative compared with nonoperative treatment were calculated to measure effect size for each study and a pooled odds ratio (OR) calculated. Results Head sphericity improved (OR, 1.29; 95% CI, 1.05-1.60) by FVO or SIO as compared with patients treated nonoperatively. In children younger than 6 years, it did not alter femoral head sphericity (OR, 1.02; 95% CI, 0.45-2.36); children 6 years of age and older were more likely to have better femoral head sphericity from surgical treatment than nonoperative treatment (OR, 2.05; 95% CI, 1.28-3.26). Conclusions The data suggest FVO or SIO in patients with LCPD disease who are older than 6 years of age during or before the fragmentation phase should be considered. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Management of Late Onset Perthes: Evaluation of Distraction by External Fixator—5-Year Follow-Up

“…These traditional open surgical procedures not only have a complication, like infection, stiffness of the hip, shortening, and resurgery for implant removal, but also alter the local anatomy. In some studies [ 23 , 24 ] these complications overweigh the benefits of intervention. The present study observes that arthrodiastasis of hip not only preserves the local anatomy but also maintains the local soft tissue integrity.…”

Comparação entre resultados de radiografia simples, pré e pós‐osteotomia de Salter, em pacientes portadores da doença de Legg‐Calvé‐Perthes

“…Esses achados estão de acordo com o que é descrito na literatura, já que diversos autores relatam que, independentemente do tipo de tratamento feito, os pacientes com idade superior aos seis anos tendem a evoluir com maior incidência de resultados insatisfatórios. 25,26 As classificaç ões de Diversos autores apontam que um dos problemas das classificaç ões radiográficas para a doença de Perthes, notadamente a de Catterall, é a baixa a moderada concordância inter-e intraobservadores. [29][30][31] A estabilidade da classificação de Herring também foi questionada recentemente por Park e colaboradores, que notaram mudança da gradação inicial em 40% dos pacientes avaliados com DLCP em radiografias obtidas de forma seriada.…”

Management of Perthes’ disease

“…Several studies suggest that children over the age of 6 years at onset of the disease and in whom more than half the epiphysis is avascular are likely to benefit from containment. 28 29 30 31 32 33 34 35 36 The chances of retaining a spherical femoral head with minimal coxa magna are greater when containment is performed.…”