Comparison of the results from simple radiography, from before to after Salter osteotomy, in patients with Legg-Calvé-Perthes disease

Toma, Hugo Futoshi; Viana, Thiago de Almeida Oliveira Felippe; Meireles, Rostanda Mart; Borelli, Isabel Moreira; Blumetti, Francesco Camara; Takimoto, Eduardo Shoiti; Dobashi, Eiffel Tsuyoshi

doi:10.1016/j.rboe.2014.09.003

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Original Article • Rev. bras. ortop. 49 (5) • Sep-Oct 2014 • https://doi.org/10.1016/j.rboe.2014.09.003 copy

Comparison of the results from simple radiography, from before to after Salter osteotomy, in patients with Legg-Calvé-Perthes disease^☆ ☆ Please cite this article as: Toma HF, de Almeida Oliveira Felippe Viana T, Meireles RM, Borelli IM, Blumetti FC, Takimoto ES, et al. Comparação entre resultados de radiografia simples, pré e pós-osteotomia de Salter, em pacientes portadores da doença deLegg-Calvé-Perthes. Rev Bras Ortop. 2014;49(5):488–93. ,^☆☆ ☆☆ Work developed in the Discipline of Pediatric Orthopedics, Department of Orthopedics and Traumatology, Paulista Medical School, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

To determine whether the clinical variables and preoperative classification of patients with Legg-Calvé-Perthes disease (LCPD) who undergo Salter osteotomy correlate with the radiographic result at the time of skeletal maturity.

Methods:

In this retrospective cohort study, 47 individuals with LCPD who were treated using Salter osteotomy (1984-2004) were evaluated. The patients were evaluated according to sex, skin color, side affected and age at which osteotomy was performed. The preoperative radiographs were analyzed in accordance with the classifications of Waldenstrom, Catter-all, Laredo and Herring. The radiographs obtained at the time of skeletal maturity were classified using the Stulberg method.

Results:

The mean age at the time of surgical treatment was 82.87 months (6.9 years). The age presented a statistically significant correlation with the Stulberg grades at skeletal maturity (p < 0.001). Patients over the age of 6.12 years tended to present less favorable results. The variables of sex, skin color and side affected did not present any statistically significant correlation with the prognosis (p= 0.425; p = 0.467; p = 0.551, respectively). Only the Laredo classification presented a statistically significant correlation with the final result given by the Stulberg classification (p = 0.001). The other classifications used (Waldenstrom, Catterall and Herring) did not present any correlation between the time at which surgery was indicated and the postoperative result.

Conclusions:

The age at which the patients underwent surgical treatment and the Laredo classification groups were the only variables that presented significant correlations with the Stulberg classification.

Legg-Calvé-Perthes disease; Radiography; Classification; Child

Variable		Frequency (n)	% Total	% Valid
Sex
	Female	10	21.3	21.3
	Male	37	78.7	78.7
	Subtotal	47	100	100
Color
	White	40	85.1	95.2
	Others	2	4.3	4.8
	Subtotal	42	89.4	100
	No information	5	10.6
Side
	Right	21	44.7	44.7
	Left	26	55.3	55.3
Waldenström classification
	I	16	34.0	34.0
	II	24	51.1	51.1
	III	5	10.6	10.6
	IV	2	4.3	4.3
Catterall classification
	II	2	4.3	4.3
	III	23	48.9	50
	IV	21	44.7	45.7
	Subtotal	46	97.9	100
	Unclassifiable	1	2.1
Herring lateral pillar classification
	A	5	10.6	10.9
	B	22	46.8	48
	C	19	40.4	41.3
	Subtotal	46	97.9	100
	Unclassifiable^a a Patients were considered to be unclassifiable when the radiographs available were only from the remodeling phase, in which most of the methods cannot be applied.	1	2.1
Laredo classification
	III	25	53.2	56.8
	IV	15	31.9	34
	V	4	8.5	9.1
	Subtotal	44	93.6	100
	Unclassifiable^a a Patients were considered to be unclassifiable when the radiographs available were only from the remodeling phase, in which most of the methods cannot be applied.	3	6.4
Stulberg classification
	I	11	23.4	24.4
	II	6	12.8	13.3
	III	18	38.3	40.0
	IV	10	21.3	22.2
	Subtotal	45	95.7	100
	Unclassifiable^a a Patients were considered to be unclassifiable when the radiographs available were only from the remodeling phase, in which most of the methods cannot be applied.	2	4.3
	Total	47	100

Variable	Mean	SD	Median	Minimum	Maximum	N
Age (months)	82.87	24.82	77	48	152	47
Length of follow-up (months)	118.07	22.76	119	67	158	47

Variable		Stulberg								Total	p
		I		II		III		IV
		n	%	n	%	n	%	n	%
Sex
	Female	3	25.0	0	0.0	5	41.7	4	33.3	12	0.425^a a Result from Mann–Whitney test.
	Male	8	22.8	6	17.2	14	40.0	7	20.0	35
Color
	White	8	21.1	5	13.2	16	42.1	9	23.7	38		0.467^a a Result from Mann–Whitney test.
	Others	1	50.0	0	0.0	1	50.0	0	0.0	2
Side
	Right	5	23.8	2	9.5	12	57.1	2	9.5	21	0.551^a a Result from Mann–Whitney test.
	Left	6	25.0	4	16.7	6	25.0	8	33.3	24
Waldenström classification
	I	5	35.7	1	7.1	6	42.9	2	14.3	14		0.052^b b Result from Spearman's correlation test.
	II	6	25.0	5	20.8	9	37.5	4	16.7	24
	III	0	0.0	0	0.0	1	20.0	4	80.0	5
	IV	0	0.0	0	0.0	2	100.0	0	0.0	2
Catterall classification
	II	2	100.0	0	0.0	0	0.0	0	0.0	2	0.260^b b Result from Spearman's correlation test.
	III	4	19.0	4	19.0	9	42.9	4	19.0	21
	IV	5	23.8	2	9.5	8	38.1	6	28.6	21
Herring lateral pillar classipcation
	A	2	40.0	0	0.0	2	40.0	1	20.0	5		0.243^b b Result from Spearman's correlation test.
	B	6	30.0	4	20.0	6	30.0	4	20.0	20
	C	3	15.8	2	10.5	9	47.4	5	26.3	19
Laredo classification
	III	7	30.4	4	17.4	11	47.8	1	4.3	23	0.001^b b Result from Spearman's correlation test.
	IV	1	6.7	1	6.7	7	46.7	6	40.0	15
	V	0	0.0	1	25.0	0	0.0	3	75.0	4
Mean age ± SD	62.91 ±19.32		80.5 ±17.55		87.94 ±21.4		97.8 ±28.91		83.02 ±25.08		<0.001^b b Result from Spearman's correlation test.
Mean LF ± SD	121.55 ±19.82		106 ±18.01		120.17 ±22.55		117.7 ±28.88		118.07 ±22.76		0.802^b b Result from Spearman's correlation test.

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E-mail: rbo@sbot.org.br

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[1] *Corresponding author. E-mail: eiffeldobashi@uol.com.br (E.T. Dobashi).