Growth disturbance in Legg-Calvé-Perthes disease and the consequences of surgical treatment.
Seventy-two patients with Legg-Calvé-Perthes disease were studied to assess the interference with proximal femoral growth as a result of the disease itself and of surgical treatment. Twenty-five patients were treated nonoperatively, 20 were treated by femoral varus derotation osteotomy, and 27 by innominate osteotomy. All patients were studied clinically for evidence of abductor weakness and leg-length discrepancy. They were also studied roentgenographically for evidence of femoral head deformity and trochanteric overgrowth. The overall results showed a 6% incidence of leg-length discrepancy greater than 2 cm after both operative and nonoperative treatment. The articulo-trochanteric distance (ATD) was less than +5 mm in 23% of patients, of which 43% had a positive Trendelenburg sign. A significantly lower mean ATD was found in patients treated by femoral varus osteotomy, which should be avoided in patients over eight years of age. The study also demonstrated a strong association between coxa magna and growth disturbance of the proximal femoral physis manifesting itself as either a leg-length discrepancy or as a low ATD. The significant effects of growth disturbance after treatment must be considered, as well as the sphericity of the healed femoral head, in the final assessment in Legg-Calvé-Perthes disease.
Leitch
J M
JM
Department of Orthopaedic Surgery, Adelaide Children's Hospital, Australia.
Paterson
D C
DC
Foster
B K
BK
D002648:Child; D002675:Child, Preschool; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000601:surgery; D005270:Femur Head / Q000000981:diagnostic imaging; D006130:Growth Disorders / Q000000981:diagnostic imaging / Q000209:etiology; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007873:Legg-Calve-Perthes Disease / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000379:methods*; D010384:Pelvic Bones / Q000601:surgery; D011859:Radiography