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

Abstract

Purpose: Treatment of Legg-Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined innominate and femoral osteotomies are generally performed to better contain and provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and a congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies.

Methods: We reviewed the radiographic changes of 20 patients with Legg-Calvé-Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 17 males and 3 females comprised 11 lateral pillar (LP) group B, 7 B/C, and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment.

Results: Among those 20 hips, six became Stulberg II (SII), nine SIII, and five SIV. From the 11 LPB hips, five became SII, four SIII, and two SIV. The seven LPB/C turned out to be SII in one case, SIII in four, and SIV in two hips. One of the two LPC hips became SIII and the other one SIV. The three female patients had one LPB, one LPB/C, and one LPC hip, and surgery resulted in SIII hips in all three cases. Eight of these 20 cases were older than 11 years of age at the time of surgery, and all had fair or poor hips.

Conclusions: Simultaneous femoral and Salter innominate osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor results to fair results.

Fig. 1

a, b Preoperative radiographs of a nine-year-old boy with group LPB left hip Legg–Calvé–Perthes. c After combined pelvic and femoral osteotomies. d, e Radiographs six years after surgery, showing a Stulberg II hip

Fig. 2

a Preoperative radiographs of an 11-year-old boy, LPB/C left hip. b After combined osteotomy. c After four-year follow-up, with Stulberg III outcome

Fig. 3

a, b Preoperative radiographs of a 9.5-year-old boy, LPB/C right hip. c After combined osteotomy. d, e After 4.5-year follow-up, with Stulberg III outcome