Comparative Study on the Results of Femoral Osteotomy and Innominate Osteotomy in LCPD

Moon, Myung Sang; Ok, In Young; Sohn, Young Ho

Abstract

Methods of treatment of Legg-Calve-Perthes' disease, (L.C.P.D.) are at present generally defined, and the individual approach is now more precise than before. But it is still controversial, particularly in older age groups. We analized the result of intertrochanteric varus osteotomy in 44 hips and innominate osteotomy in 23 hips of L.C.P.D., and compared the former with the later. To find out the influence of the both osteotomies on the femoral head (coxa magna), the relations between the stage and degree of involvement at operation and reult, and the postoperative progression of disease, the cases were analyzed and classified by Elizabethtown's stage and Catterall group. And also the duration of fragmentation stage after osteotomy was observed. Results were as follows: l. At the time of operation 45 hips were in avascular stage, 18 hips in fragmentation stage, and 4 hips in healing stage. 20 hips(29.8%) were classified as group II, 29(43. 3%) group III, and 18(23.1%) group IV. 2. After the osteotmy in case of avasculsr necrosis stage, average duration of fragmentation stage was 6.3 months after femoral osteotomy and 1 year 6 months after innominate osteotomy. 12 among 20 hips were skipped the fragmentation stage, and got into healing stage in case of femoral osteotomy. 3. After the osteotomy at the fragmentation stage, average duration of the fragmentation stage was 9.8 months after femoral osteotomy and 1 year 3 months in case of innominate osteotomy. 4. Regardless of the type of osteotomy, coxa magna was observed more frequently in the case who had surgery at the late stage and severely involoved head at the time of osteotomy. 5. In the case of femoral osteotomy, average preoperative neck shaft angle was 138.5°, and postoperative one was 113.5°. During the follow-up study, 12.0° of revalgarisation took place. 6. The result obtained by femoral osteotomy gave better results than those by innominate osteotomy. Regardless of the type of osteotomy, good results were obtained in case who had surgery at the early stage such as avascular stage, and had mild involvement as such group II.