Legg-Calvé-Perthes disease- surgical treatment options

Legg-Calvé-Perthes disease (LCPD), is a rare avascular osteonecrosis of the proximal femur usually occurring in children between 5 and 10 years of age. The cause of ischemia leading to necrosis of the femoral head remains unknown. The goal of surgical treatment for LCPD is to improve the containment of the femoral head to restore the function of the hip joint and prevent further damage to the femoral head leading to premature hip osteoarthritis. Although a causal therapy is not available, the main aim is to maintain or restore the containment of the affected hip joint. The specific surgical treatment depends on the patient's age at onset, the stage, and severity of the disease. In early stages of the disease, the most common surgical option is a containment-restoring procedure such as femoral varus osteotomy (FVO), Salter's innominate osteotomy (SIO), and triple pelvic osteotomy (TPO). Moderate forms of LCPD show good results after treatment with either FVO or SIO, severe cases are recommended to be treated with FVO combined with either SIO or TPO to provide good outcomes. In later stages with increased damage to the femoral head, surgical options may include non-containment-restoring procedures to help symptom relief or restore anatomical and biomechanical features to a certain extend e.g., femoral valgus extension osteotomy or trochanter apophyseodesis. Due to the complexity of surgical interventions and the challenging nature of LCPD it is essential to consult with an experienced surgeon in pediatric orthopedics to determine the best treatment course for the patient.