Trochanteric advancement in patients with Legg-Calvé-Perthes disease does not improve pain or limp.
Premature closure of the proximal epiphysis in patients with Legg-Calvé-Perthes disease can cause overgrowth of the greater trochanter. We asked whether distal transfer of the greater trochanter relieved pain and improved limp and whether the operation changed frontal plane kinematic and kinetic parameters of the hip and pelvis in the gait analysis. We reviewed 15 patients (15 hips) with an average age of 16.9 years (range, 13-26 years) who had the operation and were followed for a minimum of 28 months (average, 42 months; range, 28-54 months). The Iowa hip score increased from 85.0 (range, 75.5-87.0) before surgery to 89.1 (range, 83.0-97.0) at the final followup. Only three patients had no pain and Trendelenburg sign postoperatively. Pelvic obliquity angle of affected and contralateral normal hips in ipsilateral stance and contralateral swing phases remained unchanged after surgery. Hip adduction angle and abductor moment during single stance phase of affected and contralateral normal hips were not changed. We concluded trochanteric advancement does little to relieve pain and improve limp in patients with relative overgrowth of the greater trochanter and Legg-Calvé-Perthes disease.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Joo
Sun Young
SY
Department of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea.
Lee
Ki Seok
KS
Koh
Il Hyun
IH
Park
Hui Wan
HW
Kim
Hyun Woo
HW
D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D005269:Femur / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D005500:Follow-Up Studies; D005684:Gait; D006615:Hip / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D010147:Pain Measurement; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome