We evaluated growth and remodeling of the 21 hips after valgus osteotomy with rotational and sagittal components for hinge abduction in 21 patients (mean, 9.7 years) with Legg-Calvé-Perthes disease (LCPD) both clinically and radiologically. The type of osteotomy was determined by assessing the hinge movement three-dimensionally using preoperative gait assessment, 2-dimensional/3-dimensional computed tomography (2D/3D-CT), and intraoperative dynamic arthrography. The Iowa hip score averaged 66 (34 to 76) before operation and 92 (80 to 100) at a mean follow-up of 7.1 years (3.0 to 15.0). Radiographic measurements revealed favorable remodeling of the femoral head and improved hip joint mechanics. Valgus osteotomy with rotational and sagittal components results in sustained improvement in symptoms and functions and beneficially influences remodeling of the hip.

Preoperative gait assessment, 2D/3D-CT, and intra-operative dynamic arthrography are helpful for assessing the spatial features of the femoral capital hump and for determining the optimal congruent position of the hip.

Purpose: Background: Treatment of Legg-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate or combined innominate and femoral osteotomies are generally performed to better contain and provide more coverage of the femoral head by the acetabulum and thus achieve a more spherical head and a congruent joint. The purpose of the study was to show the results of both surgeries. Methods: We carried out a retrospective review of 43 hips in 41 patients (36 males, 5 females), with lateral pillar classifications of B (25 hips), B/C (12), and C (6), who had not responded to non-surgical treatment and all treated by one surgeon. They underwent Salter innominate (23 hips) or combined innominate and femoral osteotomies (20 hips). Mean age of the former group at surgery was 7 years, 11 months and of the latter, 10 years, 7 months. Combined osteotomy was performed in older children with more head involvement and stiff hips that did not respond to other treatments. Patients were evaluated with a mean follow-up of 9 years, 4 months using the Stulberg radiographic assessment. Results: Results: Stulberg I or II (SI-SII) results were attained by 57% of the innominate osteotomy group and 30% of the combined. Eleven of 14 LPB hips in the innominate group and 5 of 11 in the combined became SI-II in contrast to 2 of 5 and 1 of 7 LPB/C hips, respectively. All 6 LPC hips were classified Stulberg III or IV (SIII-IV). Children younger than 8 years in the innominate group had better results than the older children (65% vs 33%) and those younger than 10 in the combined group did better than the older (43% vs 0%). Conclusions: Conclusions: The LPB and LPB/C groups treated by innominate osteotomy had better results (more spherical heads) than those undergoing combined osteotomy, age proving a stronger prognostic factor than disease stage. The LPC led to aspherical congruent hips with either type of surgery, regardless of patient’s age. The outcome was better in LPB in children younger than 8 years of age and in LPB/C in those older than 8 years. Age of onset still remains the primary determinant of outcome in LCPD