Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease
<b>Background/Objectives</b>: Legg–Calvé–Perthes disease (LCPD) presents challenges in treatment due to its varied course and unclear etiology. This study aimed to evaluate the efficacy of combining proximal femoral varus osteotomy (PFVO) with a modified trochanteric flip osteotomy to ad...
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2025-01-01
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| author | Andrea Laufer Carina Antfang Georg Gosheger Adrien Frommer Gregor Toporowski Henning Tretow Robert Roedl Bjoern Vogt |
| author_facet | Andrea Laufer Carina Antfang Georg Gosheger Adrien Frommer Gregor Toporowski Henning Tretow Robert Roedl Bjoern Vogt |
| author_sort | Andrea Laufer |
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| description | <b>Background/Objectives</b>: Legg–Calvé–Perthes disease (LCPD) presents challenges in treatment due to its varied course and unclear etiology. This study aimed to evaluate the efficacy of combining proximal femoral varus osteotomy (PFVO) with a modified trochanteric flip osteotomy to address biomechanical consequences and improve hip abductor muscle strength. <b>Methods</b>: We present a modified approach combining PFVO with a trochanteric flip osteotomy. In this technique, the greater trochanter in compound with its muscular insertions is separated from the femur and attached distally using a varization blade plate. Nine patients (ten hips, mean age 8 years) with LCPD were treated using this technique. Clinical examination findings and radiographic evaluations were retrospectively analyzed. The median follow-up was 33 months. <b>Results</b>: At the last follow-up, two patients exhibited Trendelenburg gait, but hip abduction was improved in all patients. Radiographically, consolidation at the osteotomy site was observed in all cases with no delayed union or non-union. The median CE angle improved by 7°, while the median CCD decreased by 18°. The median MPFA decreased by 13°, resulting in a median of 82°. <b>Conclusions</b>: Combining PFVO with a modified trochanteric flip osteotomy addresses biomechanical issues associated with PFVO, potentially improving hip containment and abductor muscle strength. This approach may offer advantages over traditional osteotomy techniques in treating LCPD, and it appears to produce a superior functional outcome in particular in regard to limping when compared to conventional PFVO. Despite satisfactory radiological outcomes in most cases, further research is needed to assess long-term effectiveness and address challenges such as femoral head enlargement and persistent gait abnormalities. |
| format | Article |
| id | doaj-art-dccaf466e4284cfbb078e9f0c23b129a |
| institution | Kabale University |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Children |
| spelling | doaj-art-dccaf466e4284cfbb078e9f0c23b129a2025-01-24T13:27:07ZengMDPI AGChildren2227-90672025-01-011215110.3390/children12010051Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes DiseaseAndrea Laufer0Carina Antfang1Georg Gosheger2Adrien Frommer3Gregor Toporowski4Henning Tretow5Robert Roedl6Bjoern Vogt7Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyGeneral Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, GermanyPediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany<b>Background/Objectives</b>: Legg–Calvé–Perthes disease (LCPD) presents challenges in treatment due to its varied course and unclear etiology. This study aimed to evaluate the efficacy of combining proximal femoral varus osteotomy (PFVO) with a modified trochanteric flip osteotomy to address biomechanical consequences and improve hip abductor muscle strength. <b>Methods</b>: We present a modified approach combining PFVO with a trochanteric flip osteotomy. In this technique, the greater trochanter in compound with its muscular insertions is separated from the femur and attached distally using a varization blade plate. Nine patients (ten hips, mean age 8 years) with LCPD were treated using this technique. Clinical examination findings and radiographic evaluations were retrospectively analyzed. The median follow-up was 33 months. <b>Results</b>: At the last follow-up, two patients exhibited Trendelenburg gait, but hip abduction was improved in all patients. Radiographically, consolidation at the osteotomy site was observed in all cases with no delayed union or non-union. The median CE angle improved by 7°, while the median CCD decreased by 18°. The median MPFA decreased by 13°, resulting in a median of 82°. <b>Conclusions</b>: Combining PFVO with a modified trochanteric flip osteotomy addresses biomechanical issues associated with PFVO, potentially improving hip containment and abductor muscle strength. This approach may offer advantages over traditional osteotomy techniques in treating LCPD, and it appears to produce a superior functional outcome in particular in regard to limping when compared to conventional PFVO. Despite satisfactory radiological outcomes in most cases, further research is needed to assess long-term effectiveness and address challenges such as femoral head enlargement and persistent gait abnormalities.https://www.mdpi.com/2227-9067/12/1/51Legg–Calvé–Perthes diseasetrochanteric flip osteotomyvarus intertrochanteric osteotomyrelease cutblade plate |
| spellingShingle | Andrea Laufer Carina Antfang Georg Gosheger Adrien Frommer Gregor Toporowski Henning Tretow Robert Roedl Bjoern Vogt Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease Children Legg–Calvé–Perthes disease trochanteric flip osteotomy varus intertrochanteric osteotomy release cut blade plate |
| title | Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease |
| title_full | Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease |
| title_fullStr | Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease |
| title_full_unstemmed | Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease |
| title_short | Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease |
| title_sort | modified trochanteric flip osteotomy in varus intertrochanteric osteotomy for treatment of legg calve perthes disease |
| topic | Legg–Calvé–Perthes disease trochanteric flip osteotomy varus intertrochanteric osteotomy release cut blade plate |
| url | https://www.mdpi.com/2227-9067/12/1/51 |
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