Introduction: There are several possibilities for the treatment of Legg-Calve-Perthes (LCP) disease in older age group (more than 10 years of age): varus femoral osteotomies, different pelvic osteotomies (Salter, Chiari, triple), and the combination of pelvic and femoral osteotomies (Salter with femoral shortening).

Material and methods: We analyzed 214 hips with LCP disease surgically treated in our Institute in the period 1972–1999. Age of our patients ranged from 10–13 years. All of them were operated in the fragmentation phase of the disease. The distribution according to Catteral classification was: group II – 29 (13,5%), group III – 108 (50,5%), group IV – 77 (36%). Different risk factors were present in 154 (72%) cases. We performed: 69 (32,3%) varus femoral osteotomies, 32 (14,9%) Salter osteotomies, 69 (32,3%) Salter osteotomies with femoral shortening, 23 (10,7%) Chiariosteotomies and 21 (9,8%) triple pelvic osteotomies. There were no statistically significant differences between treatment groups (preoperatively). Postoperativelly hips were assessed clinically and radiologically. Follow-up period was in average 9,2 years (at least 3 years).

Results: All procedures showed improvement in hip containment and functional status. The best anatomical results were in the group of patients treated by triple pelvic osteotomy (p=0,02), very good results were found in the groups of patients treated by varus femoral osteotomy and Salter osteotomy with femoral shortening, whereas the results of treatment in the other groups were slightly worse. Triple pelvic osteotomy and Salter osteotomy (with or without femoral shortening) showed the best functional recovery. Positive Trendelenburg sign and waddling gait were present only in the groups of patients treated by varus femoral osteotomy and Chiariosteotomy.

Conclusion: Triple pelvic osteotomy is the best procedure for the treatment of LCP disease in the older age group

Treatment of residual acetabular dysplasia is still controversial regarding the timing of Surgery, and the type of surgical procedur

Material and Methods: We analyzed 70 patients (83 hips) operated between 1980–1988 year, in which Salter innominate osteotomy was performed in the treatment of residual acetabular dysplasia in DDH. Patients were divided in two different age groups: from 2–4 (53 hips) and 4–6 (30 hips) years. The average follow up was 7 years (from 2 to 10 years). Acetabular remodeling was radiographically assessed by measuring of the Acetabular Index (AI) at the beginning and after the 5 years of age subsequently by measuring the CE angle of Wiberg. All preoperative hips were dysplastic according to Tonnis (+2SD) criteria. Results were statistically analyzed by using the Student’s T test, and One Way Repeated Measures ANOVA, with the correction for the different age groups.

Results: We found that there were no statistically significant differences in AI and CE angle between these two age groups and between these groups and normal values.

Conclusion: We recommend Salter innominate osteotomy as a procedure of choice in the treatment of acetabular dysplasia in DDH, provided the patient is younger than 6 years of age.