[Femoral head osteotomy for complex deformity after Legg-Calvé-Perthes disease]

Complex hip deformities after Legg-Calvé-Perthes disease are characterized by an enlarged, asymmetrically deformed femoral head, a short femoral neck, a high-riding greater trochanter, and secondary acetabular dysplasia. These features lead to intra- and extra-articular impingement, instability, abductor weakness, and early osteoarthritis. Conventional osteotomies or isolated acetabular reorientations do not directly address the femoral head deformity and, therefore, show limited results. Detailed analysis of the vascular anatomy enabled the development of intracapital osteotomy with central segment resection, without significantly compromising femoral head perfusion. Since 2001, this procedure, often combined with periacetabular osteotomy (PAO), has been used to restore sphericity and joint stability. Early data demonstrate significant radiological and functional improvements. Despite its technical complexity, the procedure is considered a promising option; long-term and multicenter studies are warranted.