title: Rotational open-wedge osteotomy improves treatment outcomes for patients older than eight years with Legg-Calve-Perthes disease in the modified lateral pillar B/C border or C group.
abstract: OBJECTIVE
  Since 2003, we have been performing rotational open-wedge osteotomy (ROWO) for older children with severe Legg-Calve-Perthes disease (LCPD). We compared the treatment outcomes before and after the introduction of ROWO for patients aged ≥ eight years, classified in the modified lateral pillar B/C border or C group.
  
  
  METHODS
  Before the introduction of ROWO, conservative treatment (non-weight bearing [NWB]) was performed for all cases between 1986 and 2002, whereby there were 34 hips (NWB group). The median patient age, at the first visit, was 9.1 years. According to the lateral pillar classification, 21 hips were categorized into the B/C border group and the others into the C group. Meanwhile, 14 consecutive hips underwent ROWO combined with NWB between 2003 and 2008 (ROWO+NWB group). The median patient age, at the first visit, was 9.1 years. Six hips were in the lateral pillar B/C border group and the others were classified into the C group. There were no significant differences in pre-treatment patients' demographic data.
  
  
  RESULTS
  At the latest follow-up, according to the Stulberg classification, there were 19 class II hips, 13 class III hips, and two class IV hips in the NWB group. In the ROWO+NWB group, there were 12 class II hips, two class III hips, and no class IV hips.
  
  
  CONCLUSIONS
  The application of ROWO combined with NWB in the treatment of older children with severe LCPD improved their outcomes, compared to those obtained by NWB treatment alone.
authors: Pediatric Orthopaedic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan, nnakamura@kcmc.jp.
authors: Naoyuki
authors: N
authors: Nakamura
authors: Yutaka
authors: Y
authors: Inaba
authors: Jiro
authors: J
authors: Machida
authors: Tomoyuki
authors: T
authors: Saito
mesh_terms: D001915:Braces; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000601:surgery* / Q000628:therapy; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012399:Rotation; D016896:Treatment Outcome; D016474:Weight-Bearing