Comparison between Salter's innominate osteotomy and augmented acetabuloplasty in the treatment of patients with severe Legg-Calve-Perthes disease. Analysis of 90 hips with special reference to roentgenographic sphericity and coverage of the femoral head

This is a roentgenographic and retrospective study comparing the results of two different operative procedures used in the treatment of Legg-Calve-Perthes disease: Satter innominate osteotomy, and Augmented Acetabuloplasty. Group I comprised 43 patients (50 hips) who underwent Salter osteotomy. Another 40 patients (40 hips) were treated by Augmented Acetabuloplasty and formed Group 2. In Group 1, 11 (25.58%) patients were girls and 32 (74.42%) were boys. In Group 2, there were 4 (10%) girl and 36 (90%) boy patients. The average age was 6.62 years in Group I and 6.35 years in Group 2. Follow-up varied from 2 years to 10 years in both Groups 1 and 2. In Group 1, 18 (36%) hips were in the stage of necrosis, 28 (56%) in fragmentation, and 4 (8%) in reossification; in Group 2, 16 (40%) hips were in necrosis, 23 (57.5%) in fragmentation, and only 1 (2.5%) in reossification. M hips in necrosis were included in Satter and Thompson group 13; all hips in fragmentation were classed as Catterall group 3 or 4. Preoperative arthrographs of the 50 hips in Group I were graded according to Laredo: 29 (58%) in group 111, 18 (36%) in group IV, and 3 (6%) in group V. Only 23 of the 43 hips of Group 2 had preoperative arthrographs; there were 14 (60.87%) in group 111, 8 (34.78%) in group IV, and 1 (4.35%) in group V. The preoperative Wiberg's Center-Edge (CE) angle of Group 2 (19.4degrees) was significantly greater than that of Group 1 (16.7degrees). The percentage difference (Delta%) between immediate postoperative and preoperative CE angle was significantly greater in Group 2. The Delta% between final and immediate postoperative CE angle was significantly greater in Group I, and within Group I it was significantly greater at age 4 years to 6 years. The Delta% between final and preoperative CE angle was statistically the same in both Group I and Group 2. The distribution of good, fair and poor Mose ratings did not differ in Group I and Group 2, but there was a tendency of better results after Augmented Acetabuloplasty in children older than 6 years. Younger patients of Group 1 (4-6 years) ended up with good results at a significantly higher frequency than the older ones. Group I children with preoperative Laredo III arthrography had good results in a significantly greater number of cases, as compared with Laredo grade IV. The Delta% between final and immediate postoperative CE angle was greater in those hips with good Mose rating. (C) 2002 Lippincott Williams Wilkins.