Transtrochanteric Rotational Osteotomy for Late-Onset Legg-Calve-Perthes Disease.
Nakashima, Yasuharu MD, PhD *; Kubota, Hideaki MD, PhD +; Yamamoto, Takuaki MD, PhD *; Mawatari, Taro MD, PhD *; Motomura, Goro MD, PhD *; Iwamoto, Yukihide MD, PhD *
Journal of Pediatric Orthopaedics.
31 Centennial of Legg-Calve-Perthes Disease, 1910-2010:S223-S228, September 2011.
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Background: The pathology of late-onset Legg-Calve-Perthes disease (LCPD) is similar to that of avascular necrosis of the femoral head in adult and is associated with poorer prognosis of the hip. The optimal treatment for this condition is still controversial. The purpose of this study was to evaluate the long-term clinical results of the transtrochanteric rotational osteotomy for the patients with LCPD onset at more than 9 years of age.
Methods: Individuals included 14 hips in 13 cases with the mean age at onset of the disease and operation of 10 years 9 months and 12 years. Average follow-up periods were 12 years. All cases were resistant to the conservative treatments and did not have our indications for varus osteotomy. Clinical results were evaluated using Merle d'Aubigne Postel score and the modified Stulberg criteria.
Results: Average Merle d'Aubigne Postel score at the final follow-up was 16.2 points ranging from 12 to 18 points. All patients did not have additional treatment except nail removal. Stulberg class II, III, and IV were obtained in 5, 2, and 7 hips, respectively. More spherical femoral head was obtained in patients with less head involvement and more bone preservation or new bone formation at posterior pillar. Three hips showed slight narrowing of joint space without severe osteoarthritic changes.
Conclusions: Transtrochanteric rotational osteotomy is an effective procedure to salvage the hips of the late-onset LCPD. Amount of head involvement, posterior and lateral pillar had influences on the surgical outcomes.
Level of Evidence: Level IV (Case series), Therapeutic studies investigating the results of treatment.
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