Evaluation of femoral osteotomy in the treatment of Legg-Calvé-Perthes disease.

The optimal time and type of the varus-innerrotation femoral osteotomy in the treatment of Legg-Calvé-Perthes disease (LCPD) was evaluated on the basis of 53 hips having early operations and 14 hips having late operations and also on the basis of the previous observations on the disturbed venous drainage in various stages of LCPD. The operation should be done as early as possible in the cases in which it is indicated. Both the operative results in the present series and the theoretical background based on the severe disturbances of venous circulation in the initial phases justify an early intervention. The anatomic results of the early operated-on hips (74% good, 17% fair, and 9% poor) were related to the degree of the varusation and to the postoperative uncovering of the head. In the good results, the attained varusation was greater and the positioning of the head within the acetabulum deeper than in the fair or poor results. Accordingly, in "risk" cases, the optimal angle of the neck immediately after the varusation should be 100--100 degrees. With such varusation, it is possible to obtain good containment and a remarkable relief of the load against the femoral head during walking and running.