title: Does valgus femoral osteotomy improve femoral head roundness in severe Legg-Calvé-Perthes disease?
abstract: BACKGROUND
  Many surgeons perform a varus femoral or Salter pelvic osteotomy in patients with Legg-Calvé-Perthes (LCP) disease. However, more severely deformed femoral heads show greater congruency in adduction rather than in abduction. Therefore, a valgus-(flexion) femoral osteotomy (VFO) seems preferable rather than a varus femoral or Salter pelvic osteotomy.
  
  
  OBJECTIVE
  We evaluated whether the VFO improves (1) femoral head roundness, (2) radiographic parameters reflecting hip subluxation, and (3) function.
  
  
  METHODS
  We treated 25 patients (25 hips; 18 lateral pillar C and seven B) in the late fragmentation stage by VFO. Seven patients had additional pelvic procedures. VFO was performed at a mean age of 9.8 years. Three hips were Stulberg Class II, 20 were Class III, and two were Class IV. The following components of femoral head roundness were calculated from preoperative MRI and final radiographs: lateral and medial head roundness (LHR and MHR); anterior and posterior head roundness (AHR and PHR); central head height; and the ratios MHR/LHR and PHR/AHR. Continuity of Shenton's line, medial gap ratio were evaluated. Function was determined with the Iowa hip score. Minimum followup was 3.1 years (mean, 6.3 years; range, 3.1-11.2 years).
  
  
  RESULTS
  All femoral head roundness measurements improved, with greatest improvement in the lateral and anterior head. Pillar C hips showed greater relative improvement than pillar B hips. The continuity of Shenton's line improved and the mean medial gap ratio decreased. Mean Iowa hip score improved from 71 before surgery to 90 at the last followup.
  
  
  CONCLUSIONS
  VFO appears to help the deformed femoral head in the fragmentation stage to remodel to fit the acetabulum.
  
  
  METHODS
  Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Pusan National University Hospital, 1 Ga-10, Ami-Dong, Seo-Gu, Pusan 602-739, Korea. kimht@pusan.ac.kr
authors.forename: Hui Taek
authors.initials: HT
authors.lastname: Kim
authors.forename: Ja Kyung
authors.initials: JK
authors.lastname: Gu
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Bae
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Jang
authors.forename: Jong Seo
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome