Do Femoral or Salter Innominate Osteotomies Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease? A Meta-analysis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Recently, the authors of two prospective multicenter observational studies recommended surgery to improve head sphericity in older children, whereas large retrospective observational studies suggest that surgery does not improve head sphericity in older children. Thus, the treatment for Legg-Calvé-Perthes disease (LCPD) remains controversial.
Using a meta-analysis we asked whether femoral varus osteotomy (FVO) or Salter innominate osteotomy (SIO) resulted in better radiographic head sphericity at the end of the disease process as compared with nonsurgical modalities.
We systematically searched the literature using the key concepts LCPD, operative treatment, and nonoperative treatment. Of 160 abstracts, 57 full-text studies were reviewed and 14 papers chosen for meta-analysis. Subgroup analyses were performed to assess the impact of age and stage of disease. The odds of a spherical head after operative compared with nonoperative treatment were calculated to measure effect size for each study and a pooled odds ratio (OR) calculated.
Head sphericity improved (OR, 1.29; 95% CI, 1.05–1.60) by FVO or SIO as compared with patients treated nonoperatively. In children younger than 6 years, it did not alter femoral head sphericity (OR, 1.02; 95% CI, 0.45–2.36); children 6 years of age and older were more likely to have better femoral head sphericity from surgical treatment than nonoperative treatment (OR, 2.05; 95% CI, 1.28–3.26).
The data suggest FVO or SIO in patients with LCPD disease who are older than 6 years of age during or before the fragmentation phase should be considered.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Arkader A, Sankar WN, Amorim RM. Conservative versus surgical treatment of late-onset Legg-Calve-Perthes disease: a radiographic comparison at skeletal maturity. J Child Orthop. 2009;3:21–25. CrossRef
- Axer A, Gershuni DH, Hendel D, Mirovski Y. Indications for femoral osteotomy in Legg-Calve-Perthes disease. Clin Orthop Relat Res. 1980;150:78–87.
- Barer M. Role of innominate osteotomy in the treatment of children with Legg-Perthes disease. Clin Orthop Relat Res. 1978;135:82–89.
- Bowen JR, Foster BK, Hartzell CR. Legg-Calve-Perthes disease. Clin Orthop Relat Res. 1984;185:97–108.
- Castaneda P, Haynes R, Mijares J, Quevedo H, Cassis N. Varus-producing osteotomy for patients with lateral pillar type B and C Legg-Calve-Perthes disease followed to skeletal maturity. J Child Orthop. 2008;2:373–379. CrossRef
- Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg Br. 1971;53:37–53.
- Cooperman DR, Stulberg SD. Ambulatory containment treatment in Perthes’ disease. Clin Orthop Relat Res. 1986;203:289–300.
- Denton JR. Experience with Legg-Calve-Perthes disease (LCPD) 1968–1974 at the New York Orthopaedic Hospital. Clin Orthop Relat Res. 1980;150:36–42.
- Evans IK, Deluca PA, Gage JR. A comparative study of ambulation-abduction bracing and varus derotation osteotomy in the treatment of severe Legg-Calve-Perthes disease in children over 6 years of age. J Pediatr Orthop. 1988;8:676–682. CrossRef
- Fulford GE, Lunn PG, Macnicol MF. A prospective study of nonoperative and operative management for Perthes’ disease. J Pediatr Orthop. 1993;13:281–285. CrossRef
- Glard Y, Katchburian MV, Jacquemier M, Guillaume JM, Bollini G. Genu valgum in Legg-Calve-Perthes disease treated with femoral varus osteotomy. Clin Orthop Relat Res. 2009;467:1587–1590. CrossRef
- Grasemann H, Nicolai RD, Patsalis T, Hovel M. The treatment of Legg-Calve-Perthes disease. To contain or not to contain. Arch Orthop Trauma Surg. 1997;116:50–54. CrossRef
- Grzegorzewski A, Bowen JR, Guille JT, Glutting J. Treatment of the collapsed femoral head by containment in Legg-Calve-Perthes disease. J Pediatr Orthop. 2003;23:15–19. CrossRef
- Hardcastle PH, Ross R, Hamalainen M, Mata A. Catterall grouping of Perthes’ disease. An assessment of observer error and prognosis using the Catterall classification. J Bone Joint Surg Br. 1980;62:428–431.
- Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;213:20–33.
- Heikkinen E, Puranen J. Evaluation of femoral osteotomy in the treatment of Legg-Calve-Perthes disease. Clin Orthop Relat Res. 1980;150:60–8.
- Herring JA. Legg-Calve-Perthes disease at 100: a review of evidence-based treatment. J Pediatr Orthop. 2011;31:S137–S140. CrossRef
- Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. 2004;86:2103–2120.
- 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;86:2121–2134.
- Hoikka V, Lindholm TS, Poussa M. Intertrochanteric varus osteotomy in Legg-Calve-Perthes disease: a report of 112 hips. J Pediatr Orthop. 1986;6:600–604. CrossRef
- Hoikka V, Poussa M, Yrjonen T, Osterman K. Intertrochanteric varus osteotomy for Perthes’ disease. Radiographic changes after 2-16-year follow-up of 126 hips. Acta Orthop Scand. 1991;62:549–553. CrossRef
- Ippolito E, Tudisco C, Farsetti P. The long-term prognosis of unilateral Perthes’ disease. J Bone Joint Surg Br. 1987;69:243–250.
- Jani LF, Dick W. Results of three different therapeutic groups in Perthes’ disease. Clin Orthop Relat Res. 1980;150:88–94.
- Joseph B, Mulpuri K, Varghese G. Perthes’ disease in the adolescent. J Bone Joint Surg Br. 2001;83:715–720. CrossRef
- Joseph B, Nair NS, Narasimha Rao KL, Mulpuri K, Varghese G. Optimal timing for containment surgery for Perthes disease. J Pediatr Orthop. 2003;23:601–606. CrossRef
- Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. How does a femoral varus osteotomy alter the natural evolution of Perthes’ disease? J Pediatr Orthop B. 2005;14:10–15. CrossRef
- Joseph B, Varghese G, Mulpuri K, Narasimha Rao KL, Nair NS. Natural evolution of Perthes disease: a study of 610 children under 12 years of age at disease onset. J Pediatr Orthop. 2003;23:590–600. CrossRef
- Kamegaya M, Saisu T, Ochiai N, Hisamitsu J, Moriya H. A paired study of Perthes’ disease comparing conservative and surgical treatment. J Bone Joint Surg Br. 2004;86:1176–1181. CrossRef
- Kim HK. Legg-Calve-Perthes disease. J Am Acad Orthop Surg. 2010;18:676–686.
- Klisic PJ. Treatment of Perthes’ disease in older children. J Bone Joint Surg Br. 1983;65:419–427.
- Lack W, Feldner-Busztin H, Ritschl P, Ramach W. The results of surgical treatment for Perthes’ disease. J Pediatr Orthop. 1989;9:197–204.
- Lahdes-Vasama TT, Marttinen EJ, Merikanto JE. Outcome of Perthes’ disease in unselected patients after femoral varus osteotomy and splintage. J Pediatr Orthop B. 1997;6:229–234. CrossRef
- Laurent LE, Poussa M. Intertrochanteric varus osteotomy in the treatment of Perthes’ disease. Clin Orthop Relat Res. 1980;150:73–77.
- Leitch JM, Paterson DC, Foster BK. Growth disturbance in Legg-Calve-Perthes disease and the consequences of surgical treatment. Clin Orthop Relat Res. 1991;262:178–184.
- Lloyd-Roberts GC, Catterall A, Salamon PB. A controlled study of the indications for and the results of femoral osteotomy in Perthes’ disease. J Bone Joint Surg Br. 1976;58:31–36.
- McAndrew MP, Weinstein SL. A long-term follow-up of Legg-Calve-Perthes disease. J Bone Joint Surg Am. 1984;66:860–869.
- McElwain JP, Regan BF, Dowling F, Fogarty E. Derotation varus osteotomy in Perthes disease. J Pediatr Orthop. 1985;5:195–198.
- Mose K. Methods of measuring in Legg-Calve-Perthes disease with special regard to the prognosis. Clin Orthop Relat Res. 1980;150:103–109.
- Mose K, Hjorth L, Ulfeldt M, Christensen ER, Jensen A. Legg Calve Perthes disease. The late occurence of coxarthrosis. Acta Orthop Scand Suppl. 1977;169:1–39.
- Mukherjee A, Fabry G. Evaluation of the prognostic indices in Legg-Calve-Perthes disease: statistical analysis of 116 hips. J Pediatr Orthop. 1990;10:153–158.
- Norlin R, Hammerby S, Tkaczuk H. The natural history of Perthes’ disease. Int Orthop. 1991;15:13–16. CrossRef
- O’Hara JP, Davis ND, Gage JR, Sundberg AB, Winter RB. Long-term follow-up of Perthes’ disease treated nonoperatively. Clin Orthop Relat Res. 1977;125:49–56.
- Rowe SM, Moon ES, Song EK, Yoon TR, Kim MS, Cho SB. Residual shortening after Legg-Calve-Perthes disease, focusing on the response of the ipsilateral tibia. J Pediatr Orthop. 2005;25:296–299. CrossRef
- Salter RB, Thompson GH. Legg-Calve-Perthes disease. The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am. 1984;66:479–489.
- Slobogean GP, Verma A, Giustini D, Slobogean BL, Mulpuri K. MEDLINE, EMBASE, and Cochrane index most primary studies but not abstracts included in orthopedic meta-analyses. J Clin Epidemiol. 2009;62:1261–1267. CrossRef
- Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calve-Perthes disease. J Bone Joint Surg Am. 1981;63:1095–1108.
- Vila Verde VM, Gomes Peres JF, Costa BA. Value of the head-at-risk concept in assessing the prognosis in Legg-Calve-Perthes disease. J Pediatr Orthop. 1985;5:422–427. CrossRef
- Waldenström H. The Classic. The first stages of coxa plana by Henning Waldenström. 1938. Clin Orthop Relat Res. 1984;191:4–7.
- Wang L, Bowen JR, Puniak MA, Guille JT, Glutting J. An evaluation of various methods of treatment for Legg-Calve-Perthes disease. Clin Orthop Relat Res. 1995;314:225–233.
- 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;90:1364–1371. CrossRef
- Do Femoral or Salter Innominate Osteotomies Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease? A Meta-analysis
Clinical Orthopaedics and Related Research®
Volume 470, Issue 9 , pp 2383-2393
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Montreal Children’s Hospital, Shriners Hospital for Children, McGill University, Montreal, QC, Canada
- 2. Department of Orthopaedics, BC Children’s Hospital, A207A-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada