title: Advanced containment methods for Legg-Calvé-Perthes disease: results of triple pelvic osteotomy.
abstract: BACKGROUND
  Although surgical containment has become a mainstay for the treatment of Legg-Calvé-Perthes (LCP) disease; traditional operations (varus osteotomy of femur, Salter osteotomy) have certain limitations, sometimes resulting in a prolonged limp or inadequate containment. This paper presents the surgical method and results of triple pelvic osteotomy for containment treatment of LCP disease.
  
  
  METHODS
  This retrospective review of 39 children (40 hips; age 5 to 13 y) with LCP disease treated with triple pelvic osteotomy (1995 to 2005) included preoperative lateral pillar assessment and other measurements. Final follow-up films (minimum 3 y, range 3 to 9 y) were assessed using the modified Stulberg classification. Clinical follow-up evaluation assessed limp, limb-length inequality, range of motion, and activity level.
  
  
  RESULTS
  Twenty-one (53%) hips were graded as lateral pillar B and 19 (48%) were lateral pillar C. Four patients required further treatment before the final follow-up. At final follow-up, 42% had a good outcome (Stulberg I/II), 47% had a fair outcome (Stulberg III), and 11% had a poor outcome. Thus, 89% of patients had satisfactory (good or fair) results. There was a significant difference in outcome based on the preoperative lateral pillar, with B hips more likely to have a good outcome (65%) compared with lateral pillar C hips (12.5%) (P=0.002). There were no lateral pillar B patients with a poor outcome. Seventeen percent of the lateral pillar C patients more than or equal to age 8 had a poor outcome compared with 50% being more than age 8 with a poor outcome. Four patients (3 lateral pillar C, 1 lateral pillar B) required further surgery.
  
  
  CONCLUSIONS
  Triple pelvic osteotomy resulted in maintenance of head shape in lateral pillar B patients of all ages and in younger lateral pillar C patients. Lateral pillar C patients over age 8 were more difficult to treat, however, we still advise containment for these cases because methods are now available to deal with containment failure. Triple pelvic osteotomy is an effective treatment method for LCP patients with lateral pillar B disease and younger patients with lateral pillar C disease. This method provides effective containment, which allows prolonged remodeling while avoiding the limitations of femoral varus osteotomy (limp, short limb) and Salter osteotomy (incomplete containment).
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Orthopedics and Scoliosis, Rady Children's Hospital-San Diego, CA, USA. orthoedu@rchsd.org
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Wenger
authors.forename: Maya E
authors.initials: ME
authors.lastname: Pring
authors.forename: Harish S
authors.initials: HS
authors.lastname: Hosalkar
authors.forename: Christine B
authors.initials: CB
authors.lastname: Caltoum
authors.forename: Francois D
authors.initials: FD
authors.lastname: Lalonde
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D010384:Pelvic Bones / Q000601:surgery*; D012189:Retrospective Studies