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Background: Legg-Calvé-Perthes disease is a significant topic in pediatric orthopedics due to its high incidence and often unclear prognosis. Both conservative and surgical treatments are widely practiced today, aiming primarily to contain the femoral head, reduce stress on the affected avascular zone, and minimize loss of sphericity of the femoral head. The aim of this study is to evaluate the clinical results in early age patients with Perthes disease which undergo femur osteotomy in a single institution. Materials and Methods: A retrospective study involving 81 hips in 79 patients was conducted at a single institution. Inclusion and exclusion criteria were set. Patients with a primary diagnosis of Legg-Calvé-Perthes disease were operated on – varus femoral osteotomy was done in all patients. The patients were classified using the Stulberg and Herring classifications, and were divided into three main groups depending on the disease severity preoperatively. Clinical and radiographic results were collected and analyzed. Results: Poor clinical outcomes (Stulberg III, IV, V) were observed in 47% of the patients. There was a direct correlation between the degree of poor outcomes and the age at onset of the disease. The average limb length discrepancy was 0.9 cm (range: 0.0–2 cm), with 23 patients having a discrepancy greater than 1 cm. Twelve patients required contralateral epiphysiodesis in the knee area to equalize limb length. Conclusions: Patients with Hering B and B/C, as well as Stulberg I and II stages over the age of six, have excellent outcomes following varus femoral osteotomy. Unsatisfactory and poor results are observed in patients with Hering and Stulberg IV and V grade hip joints. The early onset of the disease, as well as the lack of a unified treatment protocol, necessitate further and more in-depth studies in this area.
Nikolay Dimitrov (Wed,) studied this question.