Femoral And Innominate Osteotomies For The Treatment Of Legg-calve Perthes Disease:

Abd El Bary Hassan Gouda

Perthes’disease of 20 hips in 20 patients had been treated between 1989 and 1993, 16 hips were treated by femoral varusderotational osteotomy, 2 hips by Salter innominate osteotomy and2 hips by combined osteotomy femoral and Salter ). Theprerequisities for innominate osteotomy were only fulfilled in 2cases and we found either procedure alone was not adequate in 2cases ( in which combined osteotomy was performed ).All cases were sUbjected to through clinical, radiological andlaboratory examination.The indications for surgical containment were : children olderthan 6 years old, Catterall group II, III or IV and at - risk. 19hips had had lateral subluxation of the femoral.head ( which is themo£t important at-risk sign ).At the end of follow up, radiological findings revealed thatthe coverage of the femoral head was markedly improved as assessedby C- E angle. According to the measuring the sphericity of thefemoral head by using the concentric circles of Mose, satisfa~toryresults were obtained following surgical containment. Good resultswere obtained in 50% of cases; fair results in 35%, while poorresults were obtained in 15% of cases cases grouped together ).The results of femoral osteotomy were 56% good; 31% fair and 13%poor.The clinical evaluation had been done for all cases based onthe range of motion of the hips, limb shortening and gait disordersgiving a higher proportion of good results. Same observation wasreported by others. The maximum amount of shortening was 2 em( not functionally disabling I. Trendlenburg’s test and gait wasposi tive in only 3 cases (15% I. On studying the range of hipmotion,the patients showed little functional disability followingoperative treatment ( 60% good; 25% fair; and 15% poor ).The results for patients aged below 9 years were much betterthan those obtained in older children. Also, the chances of goodresults steadily decreased from Catterall group II to group IV. aswell as, high incidence of good and fair results were detected whenthe epiphyseal extrusion index was less than 20 per cent.It is important to emphasized that the early results ofcontainment osteotomies were enCouraging but a longer follow upperiod should be awaited to confirm these results and to evaluatethe role of these osteotomies to prevent or to delay the latedegenerati ve arthritis in the hip joints affected by Perthes’disease.