Published online May 18, 2023. doi: 10.5312/wjo.v14.i5.328
Peer-review started: November 18, 2022
First decision: March 24, 2023
Revised: April 6, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: May 18, 2023
The treatment of late stages of Legg-Calvé-Perthes disease (LCPD) is controversial. Although the concept of femoral head containment is a well-established technique of treatment, its use remains debatable in the late stages of the disease, as it does not improve symptoms in terms of limb length discrepancy and gait.
To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.
From 2000 to 2007, 36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion (ROM) variables. The Mose classification was also assessed at the last follow-up to reflect possible remodeling. The patients were 8 years old or older at the time of surgery, in the post-fragmentation stage, and complaining of pain, limited ROM, Trendelenburg gait, and/or abductor weakness.
The preoperative IOWA score (average: 53.3) markedly improved at the 1-year post follow-up period (average: 85.41) and then slightly improved at the last follow-up (average: 89.4) (P value < 0.05). ROM improved, with internal rotation increased on average by 22° (from 10° preoperatively to 32° postoperatively) and abduction increased on average by 15.9° (from 25° preoperatively to 41° postoperatively). The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period. The tests used were the paired t-test and Pearson correlation test, where the level of significance was a P value less than 0.05.
Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.
Core Tip: This is a retrospective study on 36 patients with ages ranging from 8 to12 years with late stage Perthes disease (re-ossification and healing stages) underwent femoral valgus osteotomy with rotational component which result in pain relief, improved gait, and increased range of motion. In addition, relative neck lengthening is also achieved that can correct limb length discrepancy resulting from head deformity associated with the disease which for many patients may be the only problem encountered Preoperative hip arthrography is done to see the sphericity of the hip and whether there are lateral osteophytes or not.