Long-term Survival after Femoral Anterior Rotational Osteotomy for Late-onset Legg-Calvé-Perthes Disease: A Case Report with 27-year Follow-up?

INTRODUCTION: The purpose of treatment for Legg-Calvé-Perthes disease (LCPD) is to regain the sphericity of the femoral head in childhood and prevent degenerative changes in adulthood. Due to the largely unsatisfactory results of conservative treatment for late-onset LCPD (i.e. patient age >9 years.), surgery is generally indicated. Various surgeries have been applied and the reported short-term results are generally good. However, few reports have described the long-term (approximately 30 years) outcomes of femoral anterior rotational osteotomy (ARO). We herein report the long-term results of late-onset LCPD treated by femoral ARO.

CASE REPORT: This report describes a boy and a girl with LCPD who underwent surgical treatment at the ages of 12 and 11 years, respectively. Conservative treatment with a brace had initially been applied, but the patients subsequently developed hinge abduction; therefore, we performed femoral ARO. Five-year postoperatively, the patients' Stulberg classification was Class II and Class III, respectively. The clinical results were satisfactory after 27 years of follow-up. Slight anterior residual deformity was seen, but there were no degenerative changes.

CONCLUSION: In patients with hinge abduction, it is difficult to achieve good containment by conservative treatment, and even by surgical treatment, degenerative changes can occur in the early post-operative period. In severe cases of late-onset LCPD, a femoral ARO is performed, effectively transferring the viable posterior area of the femoral head onto the weight-bearing area. Maintaining good sphericity of the femoral head helps to prevent degenerative change and leads good long-term results. Both patients described in this report were asymptomatic and did not show any signs of degenerative change upon final examination. We did, however, confirm that the anterior head-neck junction exhibited residual deformity. ARO is a proven effective option for treating late-onset severe LCPD.