title: Joint-preserving surgery improves pain, range of motion, and abductor strength after Legg-Calvé-Perthes disease.
abstract: BACKGROUND
  Patients after Legg-Calvé-Perthes disease (LCPD) often develop pain, impaired ROM, abductor weakness, and progression of osteoarthritis (OA) in early adulthood. Based on intraoperative observations during surgical hip dislocation, we established an algorithm for more detailed characterization of the underlying pathomorphologies with a proposed joint-preserving surgical treatment.
  
  
  OBJECTIVE
  We asked if patients after LCPD treated with our algorithm experienced (1) reduced pain; (2) improved hip function; and/or (3) prevention of OA progression; we then determined (4) the intraoperative damage patterns; (5) the survival of the hip; and (6) factors predicting the need for a conversion to THA; radiographic progression of OA; a Merle d'Aubigné-Postel score below 15 at last followup; and/or the need for revision surgery.
  
  
  METHODS
  We retrospectively reviewed 53 patients after LCPD who underwent joint-preserving surgery (40 surgical hip dislocations, eight acetabular osteotomies, four combined procedures, and one intertrochanteric osteotomy). We obtained Merle d'Aubigné-Postel scores to assess pain; OA was assessed using Tönnis grades. Survival and predictive factors were calculated with the univariate Cox regression. Fifty of the 53 patients were evaluated at a minimum of 5.1 years (mean, 8.2 years; range, 5.1-12.8 years).
  
  
  RESULTS
  Pain and hip function improved at followup from a median of 4 points to 5 points. The mean increase in Tönnis grades at last followup was 0.3 to 0.8. The survival of surgery at 5 years was 86%; 13 factors related to survival.
  
  
  CONCLUSIONS
  Patients with symptoms resulting from pathomorphologic deformities after LCPD benefit from joint-preserving surgery with specific treatment of individual structural abnormalities.
authors.affiliation: Department of Orthopedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Christoph Emanuel
authors.initials: CE
authors.lastname: Albers
authors.forename: Simon Damian
authors.initials: SD
authors.lastname: Steppacher
authors.forename: Reinhold
authors.initials: R
authors.lastname: Ganz
authors.forename: Klaus Arno
authors.initials: KA
authors.lastname: Siebenrock
authors.forename: Moritz
authors.initials: M
authors.lastname: Tannast
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip; D001696:Biomechanical Phenomena; D002648:Child; D018450:Disease Progression; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000601:surgery*; D019637:Orthopedic Procedures; D015207:Osteoarthritis, Hip / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D010027:Osteotomy; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D018579:Patient Selection; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult