title: Transtrochanteric rotational osteotomy for late-onset Legg-Calve-Perthes disease.
abstract: BACKGROUND
  The pathology of late-onset Legg-Calve-Perthes disease (LCPD) is similar to that of avascular necrosis of the femoral head in adult and is associated with poorer prognosis of the hip. The optimal treatment for this condition is still controversial. The purpose of this study was to evaluate the long-term clinical results of the transtrochanteric rotational osteotomy for the patients with LCPD onset at more than 9 years of age.
  
  
  METHODS
  Individuals included 14 hips in 13 cases with the mean age at onset of the disease and operation of 10 years 9 months and 12 years. Average follow-up periods were 12 years. All cases were resistant to the conservative treatments and did not have our indications for varus osteotomy. Clinical results were evaluated using Merle d'Aubigne Postel score and the modified Stulberg criteria.
  
  
  RESULTS
  Average Merle d'Aubigne Postel score at the final follow-up was 16.2 points ranging from 12 to 18 points. All patients did not have additional treatment except nail removal. Stulberg class II, III, and IV were obtained in 5, 2, and 7 hips, respectively. More spherical femoral head was obtained in patients with less head involvement and more bone preservation or new bone formation at posterior pillar. Three hips showed slight narrowing of joint space without severe osteoarthritic changes.
  
  
  CONCLUSIONS
  Transtrochanteric rotational osteotomy is an effective procedure to salvage the hips of the late-onset LCPD. Amount of head involvement, posterior and lateral pillar had influences on the surgical outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan. yasunaka@ortho.med.kyushu-u.ac.jp
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kubota
authors.forename: Takuaki
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Taro
authors.initials: T
authors.lastname: Mawatari
authors.forename: Goro
authors.initials: G
authors.lastname: Motomura
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D005260:Female; D005270:Femur Head / Q000473:pathology / Q000601:surgery; D005271:Femur Head Necrosis / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome