Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease
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Khaled M Emara1, Ramy Ahmed Diab2, Ahmed K Emara3
1Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt. kmemara@hotmail.com.
Insights
Subtrochanteric valgus osteotomy effectively relieved symptoms in patients with late-stage Legg-Calvé-Perthes disease (LCPD). This surgical intervention improved pain and range of motion, offering a viable treatment option for this challenging condition.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Hip Preservation Surgery
Background:
- Treatment for late-stage Legg-Calvé-Perthes disease (LCPD) remains controversial.
- Femoral head containment, a common technique, shows limited benefits for late-stage LCPD symptoms like gait and limb length discrepancy.
Purpose of the Study:
- To evaluate the outcomes of subtrochanteric valgus osteotomy in patients with symptomatic late-stage Perthes disease.
- To assess the efficacy of this surgical approach in improving patient function and hip joint mechanics.
Main Methods:
- A cohort of 36 symptomatic patients (≥8 years old) with late-stage LCPD underwent subtrochanteric valgus osteotomy.
- Follow-up ranged from 8 to 11 years, assessing IOWA scores, range of motion (ROM), and Mose classification for femoral head remodeling.
Main Results:
- Significant improvement in IOWA scores from 53.3 preoperatively to 89.4 at final follow-up (P < 0.05).
- Enhanced ROM, including a 22° increase in internal rotation and a 15.9° increase in abduction.
- Mean Mose deviation of 4.1 mm indicated femoral head remodeling post-surgery.
Conclusions:
- Subtrochanteric valgus osteotomy provides effective symptomatic relief for patients with late-stage LCPD.
- The procedure demonstrates positive functional outcomes and potential for femoral head remodeling in this patient group.
Background:
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.
Aim:
To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease.
Methods:
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.
Results:
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.
Conclusion:
Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.
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