Long-Term Results of Derotational Femoral Varus Osteotomy in Legg-Calvé-Perthes Disease: 26-Year Follow-Up

Than, Péter; Halmai, Vilmos; Shaikh, Shoaib Ahmed; Kránicz, J; Bellyei, A

doi:10.3928/0147-7447-20030501-13

Cited by 16 publications

(8 citation statements)

References 21 publications

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“…In the 1980s, operative methods (femoral and innominate osteotomy) to offer containment became more popular for these patient groups. Advocates of femoral varus osteotomy refer to the 70-90% satisfactory results [24][25][26][27][28][29][30][31][32]. Limited studies compare conservative treatment regime(s) with femoral varus osteotomy and report variable results [13,14,17,20,[33][34][35][36][37][38][39].…”

Section: Introductionmentioning

confidence: 99%

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Wagenaar

Maathuis

Erve

2011

Journal of Children's Orthopaedics

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Purpose Compare conservative and operative treatment in the most severely affected Legg-Perthes disease patients. Methods 29 patients (14 conservative and 15 operative) with 32 affected hips (16 conservative and 16 operative) were evaluated, all Catterall 3 or 4. The conservative group, with a median age-at-onset of 4.8 (range, 2.5-9.5) years, was treated by a rigorous regime of traction in abduction for an average of two years. Follow-up was performed at a median of 28.6 (range, 17.4-31.6) years with a median patient age of 34.1 (range, 19.9-39.3) years. The operative group, with a median age-at-onset of 4.7 (range, 2.0-7.8) years, was treated by femoral varus derotation osteotomy. Follow-up was performed at a median of 14 (range, 8-21.4) years, with a median patient age of 20.7 (range, 12.8-28) years. Results Median age-at-onset (P = 0.16) and Catterall classification (P = 0.29) were comparable. No differences could be found for the Stulberg classification (P = 0.83), functional parameters (Harris Hip score and Merle d'Aubigné and Postel), and leg-length differences. Career choices were similar for both patient groups, as well.Conclusions Given methodological issues, femoral varus derotation osteotomy did not show apparent better results than the conservative containment regime in Catterall 3 and 4 patients with a median age-at-onset around 4.8 years. This result is fairly similar to recent literature suggesting a conservative approach in most severely affected patients with a young age-at-onset. However, based on unacceptable socioeconomic issues, the conservative regime evaluated in the present study cannot be justified, nowadays.

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Section: Introductionmentioning

confidence: 99%

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Wagenaar

Maathuis

Erve

2011

Journal of Children's Orthopaedics

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“…According to Catterall’s postoperative classification, good and fair results were observed in 87% of hips. Four patients (13%) had severe restriction of movement and constant hip pain, and derotational femoral varus osteotomy was recommended to treat LCPD 10. Restricted hip movement and constant hip pain were seen in 19% and 9.5% of the patients of this study, respectively.…”

Section: Discussionmentioning

confidence: 76%

“…Than et al 10 evaluated the long-term results of 30 LCPD patients (31 hips) who were treated by derotational femoral varus osteotomy. According to Catterall's postoperative classification, good and fair results were observed in 87% of hips.…”

Section: Discussionmentioning

confidence: 99%

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Short-term radiographic outcome of varus osteotomy in the treatment of Legg-Calvé-Perthes disease: a retrospective case series study

Ghaznavi

Motaghi

Ghaderi

et al. 2022

Current Orthopaedic Practice

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Background: Varus osteotomy is a popular method for the operative treatment of Legg-Calvé-Perthes disease (LCPD). In this study, the authors aimed to evaluate the radiographic outcomes of varus osteotomy and its association with the extent of hip involvement. Methods: Twenty-one patients in early stages of disease (stage I and II of LCPD, according to the modified Elizabethtown classification) who were treated with varus osteotomy were studied. The radiographic outcome measures were Caput Index and epiphyseal quotient (EQ) that were assessed before the surgery and 2 yr postoperatively. The level of hip involvement was determined by the modified lateral pillar classification. Results: The mean Caput index of the patients improved from 55.5±12.7 to 74±13.4 (P<0.001). The mean EQ of the patients improved from 47.2±12.9% to 67.8±17.1% (P<0.001). According to the EQs, the radiographic outcomes were found to be good, fair, and poor in 16 (76.1%) patients, 4 (19.1%) patients, and 1 (4.8%) patient, respectively. The mean change of Caput Index and EQ was significantly more in the B/C lateral pillar group than C lateral pillar group (P=0.04 and P=0.02, respectively). Conclusions: Varus osteotomy could be recommended as an effective surgical treatment for LCPD. The level of hip involvement at presentation could be used as independent factors of surgical prognosis. Level of Evidence: Level III.

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“…Femoral varus osteotomy is the most widely used operation to achieve containment of the femoral head in LCPD (Figure 11(c)). [79][80][81][82][83][84][85][86][87][88][89][90][91][92][93] The precise technique, including whether the osteotomy is an openwedge or a closed wedge osteotomy, the nature of internal or external fixation, and the post-operative care, varies a great deal.…”

Section: Preventive Intervention (Stages Ia Ib and Iia)mentioning

confidence: 99%

Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes

Joseph,

Shah,

Perry

2023

Journal of Children's Orthopaedics

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Background: Legg–Calvé–Perthes disease is a self-limiting disorder that develops in children following interruption of the blood supply to the capital femoral epiphysis. This review outlines the current knowledge on the epidemiology, natural evolution, clinical spectrum, and management of the disease. Methods: The literature pertaining to these aspects of the disease were studied and summarized in this review. Results: Epidemiological studies suggest that environmental factors contribute to the causation of the disease. Incidence rates monitored over time indicate that the incidence of Legg–Calvé–Perthes disease is declining. The natural evolution followed on sequential plain radiographs enables division of the disease into Stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV. Reversible deformation of the capital occurs in Stages Ia–IIa simply on standing while irreversible deformation may occur in Stages IIb and IIIa. Treatment of Legg–Calvé–Perthes disease in Stages Ia–IIa aims to prevent the femoral head from getting deformed by containment and avoidance of weight-bearing. In Stages IIb and IIIa, treatment aims to remedy the effects of early irreversible deformation of the femoral head. In Stage IIIb and IV, treatment is directed to correcting the altered shape of the femoral head. The impression that these treatment methods are helpful is based on poor quality evidence. Conclusion: There is an urgent need to undertake Level I studies to establish the efficacy of currently treatment. Level of evidence: level V.

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Long-Term Results of Derotational Femoral Varus Osteotomy in Legg-Calvé-Perthes Disease: 26-Year Follow-Up

Cited by 16 publications

References 21 publications

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Short-term radiographic outcome of varus osteotomy in the treatment of Legg-Calvé-Perthes disease: a retrospective case series study

Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes

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