Radiographic Rsults of Combined Salter Innominate and Femoral Osteotomy in Legg- Calvé- Perthes Disease in Older Children

Treatment of Legg–Calvé-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate، femoral or combined osteotomies are generally provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies. We reviewed the radiographic changes of 20 patients with Legg–Calvé–Perthes disease with a disease onset of over eight years of age who had undergone combined femoral and Salter innominate osteotomies. The hips in these 20 patients comprised 11 lateral pillar (LP) groups B، 7 B/C، and 2 C. The patients were evaluated with a mean follow-up of five years and five months using the Stulberg radiographic assessment. Among those 20 hips، six became Stulberg II (SII)، nine SIII، and five SIV. From the 11 LPB hips، five became SII، four SIII، and two SIV. The seven LPB/C turned out to be SII in one case، SIII in four، and SIV in two. One of the two LPC hips became SIII and one SIV. The three female patients had one LPB، one LPB/ C، and one LPC hip، and surgery resulted in SIII hips in all. Combined osteotomies in older children with a higher LP grouping can marginally improve the radiographic outcome in comparison with the natural history in LPB/C and LPC cases by converting a number of poor to fair results.