RETROSPECTIVE ANALYSIS OF 96 HIPS WITH SEVERE LEGG-PERTHES-CALVÉ DISEASE (CATTERALL 4, HERRING B-C, SALTER B) AT END OF GROWTH

Abstract

Purpose of the study: Special care is warranted only for severe forms of Legg-Perthes-Calvé disease (LPCd) (Catterall 4, Herring B and C, Salter B, involvement > 50%). Should we propose specific treatment or simply monitor the inevitable disease course?

Material and method: Among a series of 485 hips with LPCd, 148 (30.5%) with massive involvement were identified. Ninety-six (64.9%)severe forms were analyzed at the end of growth. Magnetic resonance imaging, scintigraphy and arteriography were used to better assess the femoral head and identify hips at risk. These hips were treated surgically: Salter osteotomy (SA), triple pelvis osteotomy (TO), or varus osteotomy (VA). Three groups of infants were identified according to age at diagnosis of LPCd: less than 6 years, 6–9 years, more than 9 years. Outcome was considered good (Stulberg 1 and 2, Mose good), fair (Stulberg 3, Mose fair), or poor (Stulberg 4 and 5, Mose poor).

Results: There were 54 hips (56.3%) in the less than 6 years group, 26 (27.1%) in the 6–9 years groups, and 16 (16.6%) in the greater than 9 years group. Outcome was good for 45 hips (46.9%), fair for 22 (22.9%) and poor for 29 (31.2%) hips and was independent of age at onset of treatment. In the less than 6 years group, 54 hips (56.3%) were Catterall 4, Herring B or C, Salter B. Among the 24 Catterall 4 hips (44.4%) treated orthopedically, outcome was good for 15 (62.5%), fair for 7 (29.2%) and poor for 2 (8.3%). Among the 30 Cartell 4 hips treated surgically, outcome was good for 16 (53.3%), fair for 9 (30%) and poor for 5 (16.7%). In the 6–9 year group, 26 hips (27.1%) were Catterall 4, Herring B or C, Salter B. Among the 10 Catteral 4 hips treated orthopedically (38.5%), outcome was good for 3 (30%), fair for 2 (20%) and poor for 5 (50%). For the 16 Catterall 4 hips treated surgically, outcome was good for 8 (50%), fair for 2 (12.5%) and poor for 6 (37.5%). In the greater than 9 years group, there were 16 (16.6%) Catterall 4, Herring B or C, Salter B hips. Among the 10 Catterall 4 hips treated orthopedically, outcome was good for 1 (10%), fair for 2 (20%) and poor for 7 (70%). Among the 6 Catterall hips treated surgically, outcome was good for 2 (33.3%), fair for 0 and poor for 4 (66.7%).

Conclusion: Good outcome decreases with age. Surgery increases the rate of good outcome in all age groups, but before the age of six years, there is no significant difference between orthopedic and surgical treatment. Before six years, spherical heads (Stulberg 1 and 2) were achieved in six out of ten hips in the 6–9 year group and in only two of ten in the group aged over 9 years.