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Advanced Containment With Triple Innominate Osteotomy in Legg-Calve-Perthes Disease: A Viable Option Even in Severe
Matthew Stepanovich1, Vidyadhar V Upasani, James D Bomar
1*Division of Orthopedic Surgery, Rady Children's Hospital, San Diego, CA †Naval Medical Center Portsmouth, Portsmouth, VA.
Insights
Triple innominate osteotomy (TIO) can benefit Legg-Calve-Perthes disease (LCPD) patients, even with severe hip involvement. While younger patients with less severe disease fare better, TIO offers a chance for good outcomes in all LCPD cases.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Surgical Outcomes
Background:
- Legg-Calve-Perthes disease (LCPD) poses challenges, especially in severe forms.
- Classifications like the modified Elizabethtown highlight LCPD stage's impact on surgical results.
- Hip severity and onset age are key determinants of LCPD outcomes.
Purpose of the Study:
- To evaluate if disease stage, severity, or patient age are absolute predictors of success for surgical containment using triple innominate osteotomy (TIO).
Main Methods:
- Retrospective review of LCPD patients treated with TIO (1995-2011) with ≥2-year follow-up.
- Exclusion of patients with prior or concurrent femoral osteotomies.
- Classification of disease stage (modified Elizabethtown), severity (Catterall, lateral pillar), and outcome (Stulberg).
Main Results:
- No significant difference in outcomes between early and late LCPD stages (P=0.842).
- No significant difference in outcomes between Catterall I/II and III/IV classifications (P=0.304).
- Trends suggest better outcomes for lateral pillar B/BC (P=0.076) and younger patients (≤8.0 years, P=0.085).
Conclusions:
- Good radiographic outcomes in LCPD treated with TIO are not solely dependent on disease stage.
- TIO is generally more effective in younger patients with less severe LCPD.
- Surgical containment with TIO should be considered for all LCPD hips, including severe cases, acknowledging a potentially higher failure rate but achievable good results.
Background:
Legg-Calve-Perthes disease (LCPD), in its severe form, remains a challenge. More recent classifications, particularly the modified Elizabethtown classification, have highlighted the chronologic stage of LCPD and its effect on surgical outcome. Hip severity and age of disease onset have also been shown to be powerful determinants of outcome. This study was performed to determine whether disease stage, disease severity, or patient age, are absolute indicators of whether a patient can benefit from surgical containment with triple innominate osteotomy (TIO).
Methods:
All patients with LCPD treated with TIO between 1995 and 2011 were collected. Only those patients with a minimum of 2-year radiographic follow-up and no previous or concomitant femoral realignment surgery were included. Fifty-four patients (56 hips) met our inclusion criteria. The modified Elizabethtown classification was used to classify disease stage as early (
Results:
Fifty-one males and 3 females with a mean chronological age at surgery of 8.2±1.8 years were included (2 bilateral cases). Mean follow-up was 72.8±30.2 months. There was no significant difference in the proportion of Stulberg good versus poor outcomes when comparing hips that were graded as early or late stage (P=0.842), or Catterall I and II versus III and IV (P=0.304). Although not statistically significant, patients with lateral pillars B and BC (P=0.076) and patients who were aged 8.0 and younger trended toward doing better compared with lateral pillar C and over age 8.0 (P=0.085), respectively.
Conclusions:
Radiographic results demonstrate that good outcomes are not entirely dependent on the stage of disease in LCPD when containment is performed with TIO. As expected, TIO appears to be more effective in younger patients with less severe disease. We conclude that even severely involved LCPD hips, independent of age, should be offered surgical containment. The failure rate in this group is higher, as expected, but many achieve good results and there are treatment methods available to those who fail containment.
Level Of Evidence:
Level IV.
