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Single Versus Combined Procedures for Severely Involved Legg-Calvé-Perthes Disease
Makoto Kamegaya1, Mitsuaki Morita1, Takashi Saisu2
1Chiba Child & Adult Orthopaedic Clinic, (Chiba Pediatric Orthopaedic Group), 3-24-2 Oyumino-minami, Midori-ku, Chiba city, Chiba.
Insights
Combined surgical procedures significantly improved outcomes for severe Legg-Calvé-Perthes disease compared to single procedures. This approach offers better femoral head remodeling and may prevent adult hip osteoarthritis.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hip joint biomechanics
Background:
- Legg-Calvé-Perthes disease can lead to femoral head deformity, with limited success from current treatments.
- Conventional single procedures show variable effectiveness.
- Data on combined surgical approaches for severe cases is scarce.
Purpose of the Study:
- To evaluate the effectiveness of combined surgical procedures versus single procedures for severe Legg-Calvé-Perthes disease.
- To compare radiological and clinical outcomes between treatment groups.
Main Methods:
- A therapeutic study (Level III) involving 77 patients (79 hips) with severe Legg-Calvé-Perthes disease.
- Patients were divided into two groups: single procedure (femoral varus osteotomy) and combined procedures (femoral varus osteotomy + Dega osteotomy).
- Outcomes were assessed using Stulberg classification, caput index, acetabulum-head index, α-angle, and clinical evaluations over an average 9.5-year follow-up.
Main Results:
- Combined procedures resulted in significantly better outcomes (Stulberg I/II) compared to single procedures (65.6% vs. 38.3%, P=0.031).
- Remodeling efficacy (caput index change) was significantly higher in the combined group (12.7% vs. 3.9%, P=0.005).
- Combined procedures also showed statistically significant improvements in acetabulum-head index, α-angle, and clinical evaluations.
Conclusions:
- Combined surgical procedures demonstrate superior clinical and radiological outcomes for severe Legg-Calvé-Perthes disease.
- This approach accelerates remodeling of the femoral head and acetabulum.
- Combined procedures may help prevent or delay adult hip osteoarthritis.
Background:
The concept of containment as an effective approach to reduce the risk of femoral head deformity has been questioned because modest results have been achieved after nonoperative and operative treatments for severely involved Legg-Calvé-Perthes disease. Several reports have shown the limited effectiveness of some conventional single procedures. However, there is limited data on the effectiveness of combined procedures.
Methods:
The surgical group comprised 77 patients (mean age 8.3 y) and involved 79 hips. The average follow-up term was 9.5 years. Sixty-five patients were unilaterally involved and 12 patients were bilaterally involved (although 10 of the latter patients only received surgery on 1 hip). Among patients, 28 hips were classified as Herring class B/C border (>8 y old) and 51 hips were Herring class C. The 79 hips were divided into 2 treatment groups for further analysis: group 1, single procedures (femoral varus osteotomy) (n=47); group 2, combined procedures [femoral varus osteotomy+Dega (Pemberton) osteotomy] (n=32).
Results:
Using Stulberg classification I and II (acceptable outcome), the final outcome was statistically significant for group 2 (21 hips, 65.6%) compared with group 1 (18 hips, 38.3%) (P=0.031). The average remodeling efficacy, defined as the change in caput index between preoperation and postoperation, was better in group 2 (12.7%) than in group 1 (3.9%) (P=0.005). The acetabulum-head index and α-angle were also statistically significant in group 2 than in group 1 at the last follow-up. Clinical evaluations were statistically significant in group 2 compared with group 1.
Conclusions:
Both clinically and radiologically, the combined procedure group demonstrated significantly better outcomes with accelerated remodeling in both the severely affected femoral heads and the acetabula compared with the single procedure group. With this procedure, we anticipate the increased likelihood of preventing or delaying coxarthroses in adulthood.
Level Of Evidence:
Level III-therapeutic study.
