, Volume 471, Issue 3, pp 1021-1027
Date: 25 Oct 2012

Does Valgus Femoral Osteotomy Improve Femoral Head Roundness in Severe Legg-Calvé-Perthes Disease?

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Topic
Hip

Abstract

Background

Many surgeons perform a varus femoral or Salter pelvic osteotomy in patients with Legg-Calvé-Perthes (LCP) disease. However, more severely deformed femoral heads show greater congruency in adduction rather than in abduction. Therefore, a valgus-(flexion) femoral osteotomy (VFO) seems preferable rather than a varus femoral or Salter pelvic osteotomy.

Questions/purposes

We evaluated whether the VFO improves (1) femoral head roundness, (2) radiographic parameters reflecting hip subluxation, and (3) function.

Methods

We treated 25 patients (25 hips; 18 lateral pillar C and seven B) in the late fragmentation stage by VFO. Seven patients had additional pelvic procedures. VFO was performed at a mean age of 9.8 years. Three hips were Stulberg Class II, 20 were Class III, and two were Class IV. The following components of femoral head roundness were calculated from preoperative MRI and final radiographs: lateral and medial head roundness (LHR and MHR); anterior and posterior head roundness (AHR and PHR); central head height; and the ratios MHR/LHR and PHR/AHR. Continuity of Shenton’s line, medial gap ratio were evaluated. Function was determined with the Iowa hip score. Minimum followup was 3.1 years (mean, 6.3 years; range, 3.1–11.2 years).

Results

All femoral head roundness measurements improved, with greatest improvement in the lateral and anterior head. Pillar C hips showed greater relative improvement than pillar B hips. The continuity of Shenton’s line improved and the mean medial gap ratio decreased. Mean Iowa hip score improved from 71 before surgery to 90 at the last followup.

Conclusions

VFO appears to help the deformed femoral head in the fragmentation stage to remodel to fit the acetabulum.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One or more of the authors (HTK) has received funding from Pusan National University Hospital.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his institution has approved the human use protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for clinical participation in the study was obtained.
This work was performed at the Pediatric Orthopedics, Pusan National University Hospital, Pusan, Korea.