[Rotational acetabular osteotomy in the treatment of Legg-Calve-Perthes disease].
OBJECTIVE
The material of prospective study involving 57 surgically treated hips in 55 patients suffering with a severe form of Legg-Calvé-Perthes disease (LCPD) was analysed by the use of statistical methods to depict the influence of age, of sex, of the amount of head involvement on the outcomes of surgical treatment by rotational acetabular osteotomy (Salter or Steel osteotomy from 9 years of age).


METHODS
During the period 1990-2000 rotational acetabular osteotomy for Legg-Calvé-Perthes disease was performed totally in 124 patients. Excluded were cases, in which the operation was done for residual subluxation as a definitive outcome of former LCPD, cases which did not return for controls, cases with not yet completed consolidation after surgery and cases operated by me abroad. Totally were analysed stastistical sheets from 57 rotational acetabular osteotomies, including basis dates from medical history, clinical and x-ray examinations. Special concern was given to the evaluation of remodellation of the affected femoral head chronologically.


METHODS
All patients were operated by the group of three senior orthopaedic surgeons. Indication for surgery was based on the evidence of the progressive collapse of the femoral head issuing in the lateral and anterior head extrusion. As the Mose as well as Stulberg classification are showing inter-rater discrepancies, authors measured as well head-neck index, epiphyseal index and acetabulum-head index to eliminate subjectives errors.


RESULTS
Age at operation and sex did not affect the results expressed in epiphyseal quotient and acetabulum-head index. With the increasing age the head-neck index dropped down depicting the progressive shortening of the femoral neck the older kids. The periods from the operation till the consolidation of the lateral pillar of the femoral head were longer in younger than in older children. Although the evaluation of results in Mose classification showed poorer results generally and also specifically in relation to the increasing age, distribution of results in Stulberg classification showed excellent and fair results in almost 90% of all treated patients.


CONCLUSIONS
Prospective study based on the use of rotational osteotomy, avoiding the routine combination with varisation of the proximal femur in older kids using in them Steel triple osteotomy, showed promising results especially in Stulberg classification. Contrary to Salter and others prerequisiting for the indication of operation only slight deformity of the affected femoral head, many of the enrolled cases appeared with the remarkable deformity of the femoral head before the operation. Rotational acetabular osteotomy showed its potential to involve the enlarged head and follow-up depicted its subsequent slow remodellation.


CONCLUSIONS
Submitted study was prepared to be matched nextly with the conservative group, which will be published in another publication. Internal analysis of the presented cohort disclosed that presented surgical treatment (Salter or Steel osteotomy respectively) assured, that irrespective of higher age, the important parameters like epiphyseal quotient and acetabulum-head index did not become worse than in younger groups. Even in the group over 9 years of age, 87.5% were categorised like excellent and fair results in Stulberg classification.
Poul
J
J
Klinika dĕtské chirurgie, ortopedie a traumatologie Dĕtské nemocnice, FN, Brno.
Vejrostová
M
M
D000077:Acetabulum / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography