Treatment of Leg-Calve-Perthes Disease (Lcpd) by Trans-Epiphyseal Drilling Combined with Adductor Tenotomy and Greater Trochanter Epiphysiodesis

Introduction: There is a long standing debate regarding the treatment of LCPD, with various methods of treatment used and no consensus regarding results and success. One of the problems in the sequel of LCPD is overgrowth of the greater trochanter and the loss of sphericity of the femoral head. The purpose of this study is to examine the effectiveness of trans-epiphyseal drilling combined with closure of the trochanteric apophysis , and to evaluate the natural history of the patients undergoing this procedure.

Methods: During 2014-2015 we treated 5 consecutive cases of LCPD. All 5 children were 7 years old at the time of the procedure and had unilateral disease in its early fragmentation stage. There were 3 boys and 2 girls. 4 of them were classified as Salter-Thompson type B and 1 was classified as type A. All the procedures were done in the same manner. Arthrography was done prior to percutaneous drilling of the epiphysis with a 3.2 cannulated drill. This was followed by percutaneous tenotomy of the adductor longus and epiphysiodesis of the greater trochanter. Post-operative management consisted of 3 months of non-weight bearing.

Results: The mean follow-up period was 16 months. 4 patients had a substantial improvement in their range of motion of the hip at follow-up. All patients had a limp prior to operation and at recent follow-up 4 patients had no limp or pain at all and 1 reported better gait and less pain. Radiographic follow-up showed improvement in regards of femoral sphericity, and no evidence of radiographic deterioration of the disease was witnessed.

Discussion: Trans-epiphyseal drilling combined with greater trochanter epiphysiodesis can be effective for the treatment of patients with LCPD in their early fragmentation stage and improve the clinical and radiographic outcome of the disease.