AI Article Synopsis
- Proximal femoral varus osteotomy (FVO) is a common treatment for Legg-Calvé-Perthes disease (LCPD) that shows good outcomes in patients aged 6-12 years, particularly during the disease's early fragmentation phase.
- A study with 50 LCPD patients assessed clinical and radiological outcomes after FVO surgery, concluding that factors such as age at onset and Lateral Pillar classification did not significantly affect results over a 3-year follow-up.
- While the study suggests that FVO can be effective regardless of age and classification within the early fragmentation phase, the small sample size and multiple variables limit the strength of the conclusions.
Article 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.
Level Of Evidence: IV; therapeutic retrospective cohort.
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| http://dx.doi.org/10.1016/j.otsr.2024.103909 | DOI Listing |
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