Salter Innominate Osteotomy in the Treatment of Severe Legg-Calv??-Perthes Disease

Abstract

Between 1979 and 1992, 32 patients (37 hips) were treated in the authors' institution by Salter osteotomy for Legg-Calvé-Perthes disease. Twenty-four patients were male and eight female. Nineteen patients were younger than 7 years of age (84 months). According to Waldenström and Jonsäter, 15 hips (45.54%) showed necrosis, 19 (51.35%) fragmentation, and 3 (8.11%) reossification. All necrotic hips were classified as Salter and Thompson B; considering those in fragmentation, 27 (79.41%) were classified as Catterall group 3 and 7 (20.59%) as group 4. Laredo's arthrographic classification, applied to 34 hips, showed 19 (55.88%) as group 3, 11 (32.35%) as group 4, and 4 (11.77%) as group 5. Mean follow-up was 115.94 months. Wiberg's center-edge angle increased significantly independent of sex and age. The clinical results according to Robinson et al did not show any correlation with sex, age, evolutionary stage, or classifications of Catterall and Mose. The final radiographic evaluation according to Mose showed 16 hips (43.26%) classified as good and 21 (56.76%) as poor. Considering the criteria of Stulberg et al for the final evaluation, 11 hips (29.73%) were included in class 1, 5 (13.51%) in class 2, 13 (35.13%) in class 3, and 6 (21.63%) in class 4. Patients younger than 7 years (84 months) showed better results. There was no significant difference between the results at first (reossification) and final evaluation (skeletal maturity).

Comparison of the results from simple radiography, from before to after Salter osteotomy, in patients with Legg-Calvé-Perthes disease

“…Ishida et al 23 studied the results from Salter osteotomy for treating 32 patients (37 hips) at skeletal maturity and observed that the hips classified by Laredo as belonging to group III presented better results than those of hips in groups IV and V. This observation corroborates the concept that adequate coverage of the femoral head before severe deformity becomes established provides an improvement in hip biomechanics and favors the remodeling process over the course of LCPD. 15 , 16 Likewise, in our study, we observed that 47.8% of the patients classified in Laredo group III evolved to Stulberg type I or II.…”

“…Few studies in the literature have correlated the results from Salter osteotomy for treating LCPD with the Stulberg classification for grading the radiographic results. 21 , 22 , 23 …”

Radiographic results of combined Salter innominate and femoral osteotomy in Legg–Calvé–Perthes disease in older children

“…Ishida et al [27] reported 17% good results on Salter innominate osteotomy in Catterall groups 3 and 4 on children older than seven years.…”

“…Pelvic osteotomy, which redirects the acetabulum and provides improvement of femoral head coverage, has a shorter period of convalescence, and corrects the shortening caused by the disease, has been advocated [10,[26][27][28].…”

Outcomes of Combined Shelf Acetabuloplasty with Femoral Varus Osteotomy in Severe Legg-Calve-Perthes (LCP) Disease: Advanced Containment Method for Severe LCP Disease

“…Although the disease extent and lateral subluxation of the femoral head in this series were more severe than those of other studies, the results did not differ from other studies that used other advanced surgical techniques ( Table 2 ). 19 20 21 22 23 24) …”