Skip to main content
SpringerLink
Log in

Arthrographic indicators for decision making about femoral varus osteotomy in Legg-Calvé-Perthes disease

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

There is not always a good outcome after a femoral varus osteotomy (FVO) in those with Legg-Calvé-Perthes disease (LCPD), even when the severity warrants surgical treatment. The purpose of this study was to find arthrographic indicators for decision making regarding the likely surgical outcome of a FVO.

Methods

We used an image of an abduction position during preoperative arthrography under general anesthesia that simulated the post-operative relationship between the femoral head and the acetabulum. In the image, we defined two indicators of how deeply the deformed epiphysis was contained within the acetabulum: an acetabular head index in abduction and an epiphyseal slip-in index. Finding the contact point between the top of epiphysis and acetabulum was the key for the epiphyseal slip-in index measurement. In 37 patients (38 hips) who underwent FVOs based on our inclusion criteria, these two indices were measured retrospectively and were analyzed for a correlation with surgical outcome. Surgical outcome was evaluated using a combination of three factors: sphericity of the femoral head (Stulberg’s classification), acetabular cover (acetabular head index), and the slope of acetabular roof.

Results

The outcome was acceptable in 20 hips (52.6%) and unacceptable in18 hips (47.4%). There was a statistically significance difference in epiphyseal slip-in index between the acceptable group (21.9 ± 2.8%) and the unacceptable group (15.0 ± 4.4%) (P < 0.0001). An index of 20% or more determined a safe zone for predicting an acceptable outcome with 80% sensitivity, 89% specificity, and a 7.2 likelihood ratio. However, the acetabular head index in abduction showed no such statistical significance.

Conclusions

In this study, we found that the epiphyseal slip-in index was a reliable indicator for predicting the effectiveness of a FVO. It is worth measuring this index when a surgeon is considering a FVO for a patient with severe LCPD. (Level of Evidence Level III.)

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Evans IK, Deluca PA, Gage JR (1988) A comparative study of ambulation-abduction bracing and varus derotation osteotomy in the treatment of severe Legg-Calvé-Perthes disease in children over 6 years of age. J Pediatr Orthop 8:676–682

    Article  CAS  Google Scholar 

  2. Fulford GE, Lunn PG, Macnicol MF (1993) A prospective study of nonoperative and operative management for Perthes’ disease. J Pediatr Orthop 13:281–285

    Article  CAS  Google Scholar 

  3. Kamegaya M, Saisu T, Ochiai N, Hisamitsu J, Moriya H (2004) A paired study of LCPD patients comparing conservative and surgical treatment groups. J Bone Joint Surg Br 86:1176–1181. doi:10.1302/0301-620X.86B8.14458

    Article  CAS  Google Scholar 

  4. Catterall A (1971) The natural history of Perthes’ disease. J Bone Joint Surg Br 53:37–53

    CAS  Google Scholar 

  5. Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH (1992) The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop 12:143–150

    Article  CAS  Google Scholar 

  6. Kamegaya M, Saisu T, Miura Y, Moriya S (2005) A proposed prognostic formula for Perthes’ disease. Clin Orthop Relat Res 440:205–208. doi:10.1097/01.blo.0000180601.23357.d9

    Article  CAS  Google Scholar 

  7. Kitakoji T, Hattori T, Iwata H (1999) Femoral varus osteotomy in Legg-Calve- Perthes disease: points at operation to prevent residual problems. J Pediatr Orthop 19:76–81. doi:10.1097/00004694-199901000-00017

    CAS  Google Scholar 

  8. Lahdes-Vasama TT, Marttinen EJ, Merikanto JEO (1997) Outcome of Perthes’ disease in unselected patients after femoral varus osteotomy and splintage. J Pediatr Orthop B 6:229–234

    Article  CAS  Google Scholar 

  9. Lloyd-Roberts GC, Catterall A, Salamon PB (1976) A controlled study of the indications for and the results of femoral osteotomy in Perthes’ disease. J Bone Joint Surg Br 58:31–36

    CAS  Google Scholar 

  10. Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM (2005) Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C Legg-calve-Perthes disease. J Pediatr Orthop B 14:88–91

    Article  Google Scholar 

  11. Joseph B, Rao N, Mulpuri K, Varghese G, Nair S (2005) How does a femoral varus osteotomy alter the natural evolution of Perthes’ disease? J Pediatr Orthop B 14:10–15

    Article  Google Scholar 

  12. Noonan KJ, Price CT, Kupiszewski SJ, Pyevich M (2001) Results of femoral varus osteotomy in children older than 9 years of age with Perthes disease. J Pediatr Orthop 21:198–204. doi:10.1097/00004694-200103000-00013

    CAS  Google Scholar 

  13. Axer A, Gershuni DH, Hendel D, Mirovski Y (1980) Indications for femoral osteotomy in Legg- Calvé-Perthes’ disease. Clin Orthop Relat Res 150:78–87

    Google Scholar 

  14. Stulberg SD, Coopermann DR, Wallensten R (1981) The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 63:1095–1108

    CAS  Google Scholar 

  15. Jonsäter S (1953) Coxa plana: a histo-pathologic and arthrographic study. Acta Orthop Scand Suppl 12

  16. Heyman CH, Hendon CM (1950) Legg-Perthes disease: a method for the measurement of the roentgenographic result. J Bone Joint Surg Am 32:767–778

    Google Scholar 

  17. Stulberg SD, Harris WH (1974) Acetabular dysplasia and development of osteoarthritis of hip. In: Proceeding of the second open scientific meeting of the hip society. Mosby, St. Louis, pp 82–93

  18. Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am 86:2103–2120

    Google Scholar 

  19. Gershuni DH, Axer A, Hendel D (1978) Arthrographic findings in Legg-Calvé-Perthes disease and transient synovitis of the hip. J Bone Joint Surg Am 60:457–464

    CAS  Google Scholar 

  20. Gallagher JM, Weiner DS, Cook AJ (1983) When is arthrography indicated in Legg-Calvé-Perthes disease? J Bone Joint Surg Am 65:900–905

    CAS  Google Scholar 

  21. Moberg A, Hansson G, Kaniklides C (2000) Acetabulum-head index measured on arthrograms in children with Legg-Calvé-Perthes disease. J Pediatr Orthop B 9:252–256

    Article  CAS  Google Scholar 

  22. Bennett JT, Stuecker R, Smith E, Winder C, Rice J (2002) Arthrographic findings in Legg-Calvé-Perthes disease. J Pediatr Orthop B 11:110–116

    Google Scholar 

  23. Segev E, Ezra E, Wientroub S, Yaniv M (2004) Treatment of severe late onset Perthes’ disease with soft tissue release and articulated hip distraction: early results. J Pediatr Orthop B 13:158–165

    Google Scholar 

  24. Weiner SD, Weiner DS, Riley PM (1991) Pitfalls in treatment of Legg-Calvé-Perthes disease using proximal femoral varus osteotomy. J Pediatr Orthop 11:20–24

    Article  CAS  Google Scholar 

  25. Heikkinen E, Puranen J (1980) Evaluation of femoral osteotomy in the treatment of Legg-Calve-Perthes’ disease. Clin Orthop Relat Res 150:60–68

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Chiba Children’s Hospital, 579-1 Heta-chou, Midori-ku, Chiba City, Chiba, 266-0007, Japan

    Makoto Kamegaya, Takashi Saisu & Makoto Takazawa

  2. Department of Orthopaedic Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-0856, Japan

    Junichi Nakamura

Authors
  1. Makoto Kamegaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Saisu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Makoto Takazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Junichi Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Makoto Kamegaya.

About this article

Cite this article

Kamegaya, M., Saisu, T., Takazawa, M. et al. Arthrographic indicators for decision making about femoral varus osteotomy in Legg-Calvé-Perthes disease. J Child Orthop 2, 261–267 (2008). https://doi.org/10.1007/s11832-008-0120-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11832-008-0120-2

Keywords

Search

Navigation