Innominate osteotomy in the treatment of Legg-Calvé-Perthes disease.
The absolute treatment of extensively involved cases of Legg-Calvé-Perthes disease (LCPD) remains unsolved. The basic principle of adequate containment of the capital femoral epiphysis in its acetabulum while minimizing the disability time is widely accepted, but the definition of adequate containment and methods of achieving this goal are controversial. Some explanations for the ambiguity are the different criteria for patient selection and the greatly dissimilar methods of evaluating results. The innominate osteotomy can be an efficacious modality of treatment for those children with a femoral head "at risk," with a good range of hip motion, and if not in late Stage III or Stage IV disease. In addition, it may be indicated when conservative treatment in severe cases is not accepted or with poor compliance and in older children with subluxated femoral heads. However, each child should be evaluated and treated individually. This procedure currently does not complicate further reconstructive surgery, such as femoral osteotomies or total hip replacement. The patient and parents should have all of the aspects of the disease, especially its stages and groups, as well as the entire spectrum of treatment modalities and their ramifications, explained to them. Only then can an intelligent decision be made jointly by the physician, patient, and parents concerning management of LCPD.