title: Single Versus Combined Procedures for Severely Involved Legg-Calvé-Perthes Disease.
abstract: BACKGROUND
  The concept of containment as an effective approach to reduce the risk of femoral head deformity has been questioned because modest results have been achieved after nonoperative and operative treatments for severely involved Legg-Calvé-Perthes disease. Several reports have shown the limited effectiveness of some conventional single procedures. However, there is limited data on the effectiveness of combined procedures.
  
  
  METHODS
  The surgical group comprised 77 patients (mean age 8.3 y) and involved 79 hips. The average follow-up term was 9.5 years. Sixty-five patients were unilaterally involved and 12 patients were bilaterally involved (although 10 of the latter patients only received surgery on 1 hip). Among patients, 28 hips were classified as Herring class B/C border (>8 y old) and 51 hips were Herring class C. The 79 hips were divided into 2 treatment groups for further analysis: group 1, single procedures (femoral varus osteotomy) (n=47); group 2, combined procedures [femoral varus osteotomy+Dega (Pemberton) osteotomy] (n=32).
  
  
  RESULTS
  Using Stulberg classification I and II (acceptable outcome), the final outcome was statistically significant for group 2 (21 hips, 65.6%) compared with group 1 (18 hips, 38.3%) (P=0.031). The average remodeling efficacy, defined as the change in caput index between preoperation and postoperation, was better in group 2 (12.7%) than in group 1 (3.9%) (P=0.005). The acetabulum-head index and α-angle were also statistically significant in group 2 than in group 1 at the last follow-up. Clinical evaluations were statistically significant in group 2 compared with group 1.
  
  
  CONCLUSIONS
  Both clinically and radiologically, the combined procedure group demonstrated significantly better outcomes with accelerated remodeling in both the severely affected femoral heads and the acetabula compared with the single procedure group. With this procedure, we anticipate the increased likelihood of preventing or delaying coxarthroses in adulthood.
  
  
  METHODS
  Level III-therapeutic study.
authors.affiliation: Chiba Child & Adult Orthopaedic Clinic, (Chiba Pediatric Orthopaedic Group), 3-24-2 Oyumino-minami, Midori-ku, Chiba city, Chiba.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kamegaya
authors.affiliation: Chiba Child & Adult Orthopaedic Clinic, (Chiba Pediatric Orthopaedic Group), 3-24-2 Oyumino-minami, Midori-ku, Chiba city, Chiba.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Morita
authors.affiliation: Division of Orthopaedic Surgery, Chiba Children's Hospital, Chiba.
authors.forename: Takashi
authors.initials: T
authors.lastname: Saisu
authors.affiliation: Division of Orthopaedic Surgery, Chiba Children's Hospital, Chiba.
authors.forename: Jun
authors.initials: J
authors.lastname: Kakizaki
authors.affiliation: Division of Orthopaedic Surgery, Chiba Children's Hospital, Chiba.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oikawa
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Segawa
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D002648:Child; D005260:Female; D005269:Femur / Q000601:surgery*; D005270:Femur Head; D005500:Follow-Up Studies; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000601:surgery*; D008297:Male; D015207:Osteoarthritis, Hip / Q000517:prevention & control*; D010027:Osteotomy / Q000379:methods*; D011184:Postoperative Period; D011871:Radiology; D012189:Retrospective Studies; D016896:Treatment Outcome