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Do Femoral or Salter Innominate Osteotomies Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease? A Meta-analysis

  • Symposium: Legg-Calvé-Perthes Disease: Where Do We Stand After 100 Years?
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Questions/purposes

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.

Methods

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.

Results

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).

Conclusions

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.

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Author information

Authors and Affiliations

  1. Montreal Children’s Hospital, Shriners Hospital for Children, McGill University, Montreal, QC, Canada

    Neil Saran MD, MHSc, FRCSC

  2. Department of Orthopaedics, BC Children’s Hospital, A207A-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada

    Renjit Varghese MBBS, MS (Orth), MHSc & Kishore Mulpuri MBBS, MS (Orth), MHSc

Authors
  1. Neil Saran MD, MHSc, FRCSC
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  2. Renjit Varghese MBBS, MS (Orth), MHSc
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  3. Kishore Mulpuri MBBS, MS (Orth), MHSc
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Corresponding author

Correspondence to Kishore Mulpuri MBBS, MS (Orth), MHSc.

Additional information

One or more of the authors (NS) has received research funding from DePuy Spine for work unrelated to this study. The institution of one or more of the authors (KM) has received funding from DePuy Spine for work unrelated to this study.

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.

This work was performed at BC Children’s Hospital, Vancouver, BC, Canada.

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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 470, 2383–2393 (2012). https://doi.org/10.1007/s11999-012-2326-3

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