Functional Outcomes of Varus Osteotomy with Locking Compression Plate Fixation in Legg-Calve-Perthes Disease

Authors

  • Duangjai Leeprakobboon, MD Department of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand
  • Sermsak Sukpanichyingyong, MD Department of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand
  • Thananit Sangkomkamhang, MD, PhD Department of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand

DOI:

https://doi.org/10.56929/jseaortho-023-0178

Keywords:

Legg-Calve-Perthes disease, femoral varus osteotomy, outcomes, Harris hip score

Abstract

Purpose: Patients with Legg-Calve-Perthes disease are treated to preserve the roundness of the femoral head. Surgical treatment includes the proximal femur or acetabulum operations, however, remains controversial. Herein, we investigated the clinical findings and outcomes of varus osteotomy with locking compression plate fixation.

Methods: We reviewed 19 children (20 hips) with Legg-Calve-Perthes disease who underwent varus osteotomy with locking compression plate fixation at our hospital. The time to re-ossification, Stulberg classification, and Harris hip score were recorded preoperatively and at the final follow-up.

Results: We included 16 boys and two girls with unilateral hip involvement and one girl with bilateral hip disease. The mean age at the time of surgery was 7.9 years. Based on the Catterall classification, one, 10, and nine patients were classified as grades II, III, and IV, respectively. All patients were followed for 33 months. The mean time to re-ossification was 167 days. At final follow-up, based on the Stulberg classification, seven, nine, and four patients were categorized as class II, III, and IV, respectively. Based on the Harris hip score, 21.1%, 47.7%, and 31.6% of patients showed excellent, good, and fair functional outcomes, respectively. The Harris hip scores at the final follow-up were significantly improved compared to preoperative values. Following adjustment for sex and disease severity, age at disease onset and time of surgery were associated with Harris hip scores.

Conclusions: Varus osteotomy with locking compression plate fixation yields good results and significantly improves functional outcomes, although patient age affects the outcomes.

Metrics

Metrics Loading ...

References

Wenger DR, Ward WT, Herring JA. Legg-Calvé-Perthes disease. J Bone Joint Surg Am 1991; 73:778-88. DOI: https://doi.org/10.2106/00004623-199173050-00020

Mazloumi SM, Ebrahimzadeh MH, Kachooei AR. Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. Arch Bone Jt Surg 2014;2:86-92.

Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am 2004;86:2121-34. DOI: https://doi.org/10.2106/00004623-200410000-00002

Adulkasem N, Phinyo P, Tangadulrat P, et al. Comparative effectiveness of treatment modalities in severe Legg Calvé Perthes disease: Systematic review and network meta analysis of observational studies. Int Orthop 2022;46:1085-94. DOI: https://doi.org/10.1007/s00264-022-05352-x

Sponseller PD, Desai SS, Millis MB. Comparison of femoral and innominate osteotomies for the treatment of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 1988;70:1131-9. DOI: https://doi.org/10.2106/00004623-198870080-00003

Nguyen NT, Klein G, Dogbey G, et al. Operative versus nonoperative treatments for Legg-Calvé-Perthes disease: a meta-analysis. J Pediatr Orthop 2012;32:697-705. DOI: https://doi.org/10.1097/BPO.0b013e318269c55d

Saran N, Varghese R, Mulpuri K. Do femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calvé-Perthes disease? A meta-analysis. Clin Orthop Relat Res 2012; 470:2383-93. DOI: https://doi.org/10.1007/s11999-012-2326-3

Costa CR, Johnson AJ, Naziri Q, et al. Review of total hip resurfacing and total hip arthroplasty in young patients who had Legg-Calvé-Perthes disease. Orthop Clin North Am 2011;42:419-22. DOI: https://doi.org/10.1016/j.ocl.2011.04.002

Nakamura T, Wada A, Yamaguchi R, et al. Does flexion varus osteotomy improve radiographic findings compared with patients treated in a brace for Late-onset Legg-Calvé-Perthes disease?. Clin Orthop Relat Res 2022. DOI: https://doi.org/10.1097/CORR.0000000000002450

Chung MK, Kwon S-S, Cho BC, et al. Incidence and risk factors of hardware-related complications after proximal femoral osteotomy in children and adolescents. J Pediatr Orthop B 2018;27:264-70. DOI: https://doi.org/10.1097/BPB.0000000000000448

Park K-W, Shah IP, Ramanathan AK, Lee TJ, Song HR. Proximal femoral osteotomy in Legg-Calvé-Perthes disease using a monolateral external fixator: surgical technique, outcome, and complications. J Pediatr Orthop B 2017;26: 329-35. DOI: https://doi.org/10.1097/BPB.0000000000000399

Swayeb E, Khairy H, Soudy E, et al. Femoral varus osteotomy for treatment of Legg Calve Perthes Disease in Zagazig University Hospitals. Zagazig univ med j 2022;122-9.

Nilsdotter A, Bremander A. Measures of hip function and symptoms: Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score (HOOS), Oxford Hip Score (OHS), Lequesne Index of Severity for Osteoarthritis of the Hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) Hip and Knee Questionnaire. Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S200-7. DOI: https://doi.org/10.1002/acr.20549

Adulyanukosol V, Lewsirirat S, Chinvattanachot G. Age and factors associated with clinical and radiological outcomes of surgical containment in Legg-Calve-Perthes Disease. JseaOrtho 2022;46:36-41. DOI: https://doi.org/10.56929/jseaortho.v46i1.11

Barnamehei H, Derakhshan AB, Zomorrodi A, et al. Hip kinetics, kinematics, and motor control differences between normal and leg length discrepancy (LLD) children during gait: Simulation and experimental. Gait Posture 2020; 81:30-1. DOI: https://doi.org/10.1016/j.gaitpost.2020.07.038

Sankar WN, Castaneda P, Joseph B. Legg-Calvé-Perthes Disease and other conditions of the hip. Pediatric orthopaedics 2020;23:1089-119.

Terjesen T, Wiig O, Svenningsen S. Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calvé-Perthes disease. Clin Orthop Relat Res 2012;470:2394-401. DOI: https://doi.org/10.1007/s11999-011-2181-7

Park K-W, Jang K-S, Song H-R. Can residual leg shortening be predicted in patients with Legg-Calvé-Perthes' disease?. Clin Orthop Relat Res 2013;471:2570-7. DOI: https://doi.org/10.1007/s11999-013-3009-4

Moghadam MH, Moradi A, Omidi-Kashani F. Clinical outcome of femoral osteotomy in patients with legg-calve´-perthes disease. Arch Bone Jt Surg 2013;1:90-3.

Sankar WN, Lavalva SM, Mcguire MF, et al. International perthes study group. Does early proximal femoral varus osteotomy shorten the duration of fragmentation in Perthes Disease? Lessons From a Prospective Multicenter Cohort. J Pediatr Orthop 2020;40:e322-8. DOI: https://doi.org/10.1097/BPO.0000000000001451

Singh KA, Shah H, Joseph B, et al. Evolution of Legg-Calvé-Perthes disease following proximal femoral varus osteotomy performed in the avascular necrosis stage: a prospective study. J Child Orthop 2020;14:58-67. DOI: https://doi.org/10.1302/1863-2548.14.190153

Elzohairy MM. Short follow-up evaluation of proximal femoral varus osteotomy for treatment of Legg-Calvé-Perthes disease. J Orthop Traumatol 2016;17:345-51. DOI: https://doi.org/10.1007/s10195-016-0412-0

Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br 2008; 90:1364-71. DOI: https://doi.org/10.1302/0301-620X.90B10.20649

Grzegorzewski A, Szymczak W, Synder M, et al. [The prognostic factors in perthes disease]. Chir Narzadow Ruchu Ortop Pol 2006;71:177-82.

Kim HKW, da Cunha AM, Browne R, et al. How much varus is optimal with proximal femoral osteotomy to preserve the femoral head in Legg-Calvé-Perthes disease?. J Bone Joint Surg Am 2011;93:341-7. DOI: https://doi.org/10.2106/JBJS.J.00830

Downloads

Published

2023-03-01

How to Cite

1.
Leeprakobboon D, Sukpanichyingyong S, Sangkomkamhang T. Functional Outcomes of Varus Osteotomy with Locking Compression Plate Fixation in Legg-Calve-Perthes Disease. JseaOrtho [Internet]. 2023 Mar. 1 [cited 2024 Jul. 16];47(2):28-34. Available from: https://www.jseaortho.org/index.php/jsao/article/view/178

Issue

Section

Original Articles

Similar Articles

You may also start an advanced similarity search for this article.