Single Versus Combined Procedures for Severely Involved Legg-Calvé-Perthes Disease

Background: The concept of containment as an effective approach to reduce the risk of femoral head deformity has been questioned because modest results have been achieved after nonoperative and operative treatments for severely involved Legg-Calvé-Perthes disease. Several reports have shown the limited effectiveness of some conventional single procedures. However, there is limited data on the effectiveness of combined procedures. Methods: The surgical group comprised 77 patients (mean age 8.3 y) and involved 79 hips. The average follow-up term was 9.5 years. Sixty-five patients were unilaterally involved and 12 patients were bilaterally involved (although 10 of the latter patients only received surgery on 1 hip). Among patients, 28 hips were classified as Herring class B/C border (>8 y old) and 51 hips were Herring class C. The 79 hips were divided into 2 treatment groups for further analysis: group 1, single procedures (femoral varus osteotomy) (n=47); group 2, combined procedures [femoral varus osteotomy+Dega (Pemberton) osteotomy] (n=32). Results: Using Stulberg classification I and II (acceptable outcome), the final outcome was statistically significant for group 2 (21 hips, 65.6%) compared with group 1 (18 hips, 38.3%) (P=0.031). The average remodeling efficacy, defined as the change in caput index between preoperation and postoperation, was better in group 2 (12.7%) than in group 1 (3.9%) (P=0.005). The acetabulum-head index and α-angle were also statistically significant in group 2 than in group 1 at the last follow-up. Clinical evaluations were statistically significant in group 2 compared with group 1. Conclusions: Both clinically and radiologically, the combined procedure group demonstrated significantly better outcomes with accelerated remodeling in both the severely affected femoral heads and the acetabula compared with the single procedure group. With this procedure, we anticipate the increased likelihood of preventing or delaying coxarthroses in adulthood. Level of Evidence: Level III—therapeutic study.