title: The Long-Term Outcome After Varus Derotational Osteotomy for Legg-Calvé-Perthes Disease: A Mean Follow-up of 42 Years.
abstract: BACKGROUND
  Varus derotational osteotomy (VDRO) is one of the most common surgical treatments for Legg-Calvé-Perthes disease, yet its long-term results have not been fully assessed. We aimed to determine the long-term clinical and radiographic outcomes following VDRO.
  
  
  METHODS
  Forty patients (43 hips) who underwent VDRO for Legg-Calvé-Perthes disease at our institution from 1959 to 1983, and participated in a follow-up study completed 10 years earlier, were approached for the present study. Clinical examination and radiographs were evaluated. Hip status and well-being were assessed with the Harris hip score and the Short Form-36 (SF-36).
  
  
  RESULTS
  Thirty-five patients (37 hips) participated in the study. Information regarding the need for an arthroplasty was gathered on 4 additional hips from the previous study. The mean follow-up was 42.5 years (range, 32.4 to 56.5 years), with a mean patient age of 50.2 years (range, 35.9 to 67.8 years). In total, 7 patients (7 hips; 17% of 41 hips for which information was available, including 1 hip from the original cohort of 40 patients [43 hips]), underwent a total hip arthroplasty for hip pain. Excluding patients who had undergone an arthroplasty, the mean Harris hip and SF-36 scores were 79.8 points (range, 23.1 to 100 points) and 74.8 (range, 15.1 to 100), respectively. Twenty (64.5%) of the 31 hips that had not been replaced achieved a good or excellent Harris hip score (≥80 points). Sixteen (57.1%) of 28 hips with follow-up radiographs had no, or minimal, signs of osteoarthritis. The Stulberg classification was associated with the Harris hip score, the SF-36 score, hip pain, a Trendelenburg sign, coxa magna, and the Tönnis grade. In a multivariate analysis, the Stulberg classification was the only factor associated with fair or poor outcomes (a Harris hip score of <80 points). Patients with a Stulberg class-III or IV hip had significant deterioration with respect to the Harris hip score and Tönnis grade during the 10-year period since the last follow-up.
  
  
  CONCLUSIONS
  A long-term follow-up of patients who were operatively treated for Legg-Calvé-Perthes disease revealed that a low proportion underwent total hip arthroplasty and a relatively high proportion maintained good clinical and radiographic outcomes.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel noam.shohat@gmail.com.
authors.forename: Noam
authors.initials: N
authors.lastname: Shohat
authors.affiliation: Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Leonel
authors.initials: L
authors.lastname: Copeliovitch
authors.affiliation: Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Smorgick
authors.affiliation: Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Atzmon
authors.affiliation: Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Mirovsky
authors.affiliation: Department of Radiology, Carmel Medical Center, Haifa, Israel.
authors.forename: Nogah
authors.initials: N
authors.lastname: Shabshin
authors.affiliation: Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Yiftah
authors.initials: Y
authors.lastname: Beer
authors.affiliation: Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Agar
mesh_terms: D000293:Adolescent; D019644:Arthroplasty, Replacement, Hip; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome