Outcome at Skeletal Maturity of Femoral Varus Osteotomy on Late Onset Legg-Calvé-Perthes Disease

Late-onset Legg-Calvé-Perthes disease, which is diagnosed in children older than 8 years old, is considered to have a poorer outcome. The outcome depends on the severity of the disease, the age at presentation, and the method of treatment. This study aims to evaluate the effectiveness of containment using femoral varus osteotomy (FVO) in late-onset Legg-Calvé-Perthes disease patients.

We reviewed seven patients with Legg-Calvé-Perthes disease aged nine and older (four Herring B and three Herring C) who had containable hip included two cases of pseudo hinged abduction. All patients went through FVO at the subtrochanteric level, with the varus adjustment guided by an image intensifier to ensure hip containment in a neutral position, and the site was then fixed with a plate. The outcomes were assessed based on Stulberg classification of radiograph at skeletal maturity with a mean follow-up of 9.99 years.

All seven patients that went through FVO were between nine to eleven years old. Among the four Herring B patients, one had Stulberg I, one had Stulberg II, and two had Stulberg III. All three Herring C patients had Stulberg III.

Femoral varus osteotomy produces a reasonable outcome in patients of nine years and older, including those with pseudo-hinge abduction.