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Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease.

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Title: Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease.
Authors: Laufer, Andrea, Antfang, Carina, Gosheger, Georg, Frommer, Adrien, Toporowski, Gregor, Tretow, Henning, Roedl, Robert, Vogt, Bjoern
Source: Children; Jan2025, Vol. 12 Issue 1, p51, 10p
Subject Terms: HIP joint radiography, HIP joint physiology, BIOMECHANICS, POSTOPERATIVE care, RESEARCH funding, LEGG-Calve-Perthes disease, TREATMENT effectiveness, OSTEOTOMY, ORTHOPEDIC surgery, MUSCLE strength, JOINT radiography, PATIENT aftercare, EVALUATION, CHILDREN
Abstract: Background/Objectives: 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. Methods: 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. Results: 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°. Conclusions: 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. [ABSTRACT FROM AUTHOR]
Copyright of Children is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease.
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  Data: Children; Jan2025, Vol. 12 Issue 1, p51, 10p
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  Data: <searchLink fieldCode="DE" term="%22HIP+joint+radiography%22">HIP joint radiography</searchLink><br /><searchLink fieldCode="DE" term="%22HIP+joint+physiology%22">HIP joint physiology</searchLink><br /><searchLink fieldCode="DE" term="%22BIOMECHANICS%22">BIOMECHANICS</searchLink><br /><searchLink fieldCode="DE" term="%22POSTOPERATIVE+care%22">POSTOPERATIVE care</searchLink><br /><searchLink fieldCode="DE" term="%22RESEARCH+funding%22">RESEARCH funding</searchLink><br /><searchLink fieldCode="DE" term="%22LEGG-Calve-Perthes+disease%22">LEGG-Calve-Perthes disease</searchLink><br /><searchLink fieldCode="DE" term="%22TREATMENT+effectiveness%22">TREATMENT effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22OSTEOTOMY%22">OSTEOTOMY</searchLink><br /><searchLink fieldCode="DE" term="%22ORTHOPEDIC+surgery%22">ORTHOPEDIC surgery</searchLink><br /><searchLink fieldCode="DE" term="%22MUSCLE+strength%22">MUSCLE strength</searchLink><br /><searchLink fieldCode="DE" term="%22JOINT+radiography%22">JOINT radiography</searchLink><br /><searchLink fieldCode="DE" term="%22PATIENT+aftercare%22">PATIENT aftercare</searchLink><br /><searchLink fieldCode="DE" term="%22EVALUATION%22">EVALUATION</searchLink><br /><searchLink fieldCode="DE" term="%22CHILDREN%22">CHILDREN</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background/Objectives: 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. Methods: 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. Results: 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°. Conclusions: 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. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label:
  Group: Ab
  Data: <i>Copyright of Children is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.3390/children12010051
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 10
        StartPage: 51
    Subjects:
      – SubjectFull: HIP joint radiography
        Type: general
      – SubjectFull: HIP joint physiology
        Type: general
      – SubjectFull: BIOMECHANICS
        Type: general
      – SubjectFull: POSTOPERATIVE care
        Type: general
      – SubjectFull: RESEARCH funding
        Type: general
      – SubjectFull: LEGG-Calve-Perthes disease
        Type: general
      – SubjectFull: TREATMENT effectiveness
        Type: general
      – SubjectFull: OSTEOTOMY
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      – SubjectFull: ORTHOPEDIC surgery
        Type: general
      – SubjectFull: MUSCLE strength
        Type: general
      – SubjectFull: JOINT radiography
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      – SubjectFull: PATIENT aftercare
        Type: general
      – SubjectFull: EVALUATION
        Type: general
      – SubjectFull: CHILDREN
        Type: general
    Titles:
      – TitleFull: Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg–Calvé–Perthes Disease.
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              Text: Jan2025
              Type: published
              Y: 2025
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