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Results show good long-term prognosis of osteotomy for Legg-Calvé-Perthes disease
During the long-term follow-up, many patients maintained good clinical and radiographic outcomes, according to investigators.
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Varus derotational osteotomy yields good long-term results for patients with Legg-Calvé-Perthes disease, according to study results that included some patients who were treated as children and were followed up for more than 50 years.
“The long-term outcomes of varus derotational osteotomy [VRDO] are relatively good with a low proportion undergoing total hip arthroplasty and a relatively high proportion maintaining good clinical and radiographic outcomes,” Noam Shohat, MD, of Assaf Harofeh Medical Center in Zerifin, Israel, which is affiliated with Tel-Aviv University, told Orthopaedics Today Europe. “It supports the use of surgical treatment in selected patients with Legg-Calvé-Perthes disease.”
“Our work presents important information to be relayed in patient consultation, regarding expected long-term prognosis,” Shohat continued.
Extended evaluation of results
Although VRDO is one of the most common surgical treatments for Legg-Calvé-Perthes disease, this is the first study to evaluate the long-term clinical and radiographic results, Shohat and colleagues noted.
For this investigation, 40 patients (43 hips) who had undergone proximal VDRO for Legg-Calvé-Perthes disease from 1959 to 1983 and who had also participated in a follow-up study conducted between 2004 and 2005 were invited to participate. Average patient age at the time of VDRO surgery was 7.7 years. Mean patient age at long-term follow-up was 50.2 years.
Shohat and colleagues performed a clinical examination of each patient and assessed radiographs. In addition, they used the Harris Hip score (HHS) and the Short-Form-36 (SF-36) to evaluate the patients’ hip status and well-being.
Extensive follow-up
In all, 35 patients (37 hips) agreed to participate. The researchers also included in the study information on the need for THA in four additional hips from the first follow-up study. Mean follow up was 42.5 years (range, 32.4 to 56.5 years), they noted. The results showed seven patients underwent subsequent THA for pain.
Once Shohat and colleagues excluded patients who underwent THA, they found initial VRDO treatment yielded good results. They found the mean HHS was 79.8 points (range, 23.1 to 100 points), and the mean SF-36 score was 74.8 points (range, 15.1 to 100) at final follow-up. Twenty hips were good or excellent based on the HHS (> 80 points). Twenty-eight hips had follow-up radiographs, of which 16 hips demonstrated no or minimal signs of osteoarthritis. Multivariate analysis showed that patients with Stulberg class III or IV hips had a significant decrease in their HHS results and Tönnis grades in the 10 years since the last follow-up study was performed, according to the researchers. – by Colleen Owens
- Reference:
- Shohat N, et al. J Bone Joint Surg Am. 2016;doi:10.2106/JBJS.15.01349.
- For more information:
- Noam Shohat, MD, can be reached at the Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Beer-Yaacob, Zerifin, Israel, 70300; email: noam.shohat@gmail.com.
Disclosure: Shohat and colleagues report no relevant financial disclosures.