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Transtrochanteric rotational osteotomy for late-onset Legg-Calve-Perthes disease
Yasuharu Nakashima1, Hideaki Kubota, Takuaki Yamamoto
1Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan. yasunaka@ortho.med.kyushu-u.ac.jp
Insights
Transtrochanteric rotational osteotomy effectively salvages hips in late-onset Legg-Calve-Perthes disease (LCPD). Surgical outcomes depend on femoral head involvement and posterior/lateral pillar bone preservation.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hip joint pathology
Background:
- Late-onset Legg-Calve-Perthes disease (LCPD) resembles adult avascular necrosis with poor hip prognosis.
- Optimal treatment for late-onset LCPD remains debated.
- This study evaluates transtrochanteric rotational osteotomy for LCPD onset after age 9.
Purpose of the Study:
- To assess long-term clinical outcomes of transtrochanteric rotational osteotomy in late-onset LCPD.
- To evaluate the effectiveness of this surgical procedure for salvage hip procedures.
Main Methods:
- 14 hips in 13 patients with LCPD onset >9 years underwent surgery.
- Average age at onset and operation were 10y 9m and 12y, respectively.
- Clinical results assessed using Merle d'Aubigne Postel score and modified Stulberg criteria after a 12-year average follow-up.
Main Results:
- Average Merle d'Aubigne Postel score was 16.2 (range 12-18) at final follow-up.
- Stulberg classifications II, III, and IV were achieved in 5, 2, and 7 hips, respectively.
- Good head sphericity correlated with less head involvement and preserved posterior pillar bone.
Conclusions:
- Transtrochanteric rotational osteotomy is effective for salvaging hips in late-onset LCPD.
- Femoral head involvement and posterior/lateral pillar status influence surgical outcomes.
- The procedure offers a viable option for patients resistant to conservative treatment.
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.
