Proximal femoral varus osteotomy for Legg–Calvé–Perthes disease: Do age and lateral pillar classifications influence short-to-mid-term clinical and radiological outcomes? - 15/06/24

Doi : 10.1016/j.otsr.2024.103909

Nima Hoseini-Zare ^a,^b,^{^{1
Nima Hoseini-Zare and Peyman Mirghaderi contributed equally to this work (co-first authors).}}, Peyman Mirghaderi ^a,^b,^{^{1
Nima Hoseini-Zare and Peyman Mirghaderi contributed equally to this work (co-first authors).}} , Brice Ilharreborde ^c, Kiarash Roustai-Geraylow ^d, Alireza Moharrami ^b, Taghi Baghdadi ^e, Seyed Hadi Kalantar ^b,^f, Mohammad Hossein Nabian ^c,^g,⁎
^a Surgical research society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
^b Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
^c Pediatric Orthopaedic Surgery Department, Robert-Debré University Hospital, Assistance publique–Hôpitaux de Paris (AP–HP), Paris University, 48, boulevard Sérurier, 75019 Paris, France
^d Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
^e Pediatric Orthopaedic Department, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
^f Orthopaedics Department, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
^g Center for Orthopedic Trans-Disciplinary Applied Research (COTAR), Tehran University of Medical Sciences, Tehran, Iran

^⁎Corresponding author at: Department Of Orthopedic and Trauma Surgery, Shariati Hospital and School of Medicine, Tehran University Of Medical Sciences, Tehran, Iran.Department Of Orthopedic and Trauma Surgery, Shariati Hospital and School of Medicine, Tehran University Of Medical SciencesTehranIran

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 15 June 2024

Abstract

Introduction

Proximal femoral varus osteotomy (FVO) is one of the most used treatment methods with acceptable outcomes for Legg–Calvé–Perthes disease (LCPD). We aimed to investigate the influence of age at disease onset and the Lateral Pillar classification on clinical and radiological outcomes of FVO surgery LCPD patients between 6–12years of age.

Hypothesis

Proximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up, regardless of preoperative age and Herring type.

Material and methods

Fifty patients with LCPD (Herring groups B, B/C, and C) who underwent FVO were retrospectively reviewed. We evaluated radiological [center-edge angle, extrusion index, epiphyseal index, acetabular index, articulo-trochanteric distance (ATD)] and clinical [hip abduction range of motion (ROM), Trendelenburg sign, pain, and Harris hip score (HHS)] outcomes with a follow-up of 37.3±10.5months (range: 24–180months). Finally, the overall treatment outcome was assessed using the Stulberg classification.

Results

The ROC curve analysis did not reveal any significant relationship between age and clinical or radiological outcomes, and there was no predictable age cut-off for surgical outcomes (p=0.13). No significant difference was found in Stulberg classification at the follow-up between patients with type B, B/C, and C of the lateral pillar (p>0.05).

Discussion

Our results demonstrated that open-wedge proximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up. Each sample of our study was very small and a lot of variables were measured, making this result not adequately strong enough to draw a robust conclusion. However, FVO surgery remains a possible suggestion for patients in the early fragmentation phase, and age and lateral pillar type may not be limiting factors.