Novel Approach for the Treatment of Leg-Calve-Perthes Disease (LCPD) by Trans-epiphyseal Drilling Combined with Greater Trochanter Epiphysiodesis

Introduction: There is no consensus regarding the treatment of LCPD. The most common sequel of LCPD at the end of the disease is overgrowth of the greater trochanter with flat femoral head. The purpose of this study was to examine the effectiveness of trans-epiphyseal drilling combined with closure of the greater trochanter apophysis.

Methods: During 2014-2016 we treated 12 consecutive cases of LCPD. The average age at the time of the procedure was 7.7 years old (range 6-10 years) , and all had unilateral disease in initial or fragmentation stage. The treatment protocol included hip arthrography prior to percutaneous drilling of the femoral head epiphysis with a 3.2 cannulated drill. This was followed by percutaneous tenotomy of the adductor longus and epiphysiodesis of the greater trochanter apophysis carried out by drilling. Post-operative management consisted of 3 months of non-weight bearing.

Results: The mean follow-up period was 16 months. 10 patients had substantial improvement in their hip range of motion at follow-up. All patients had a limp prior to operation and at recent follow-up 9 out of 12 patients had no limp or pain at all. Radiographic follow-up showed that in the majority of patients there was no deterioration of the epiphysio-trochanteric distance.

Conclusions: Based on our preliminary experience this protocol is a minimally invasive procedure that can be effective for the treatment of patients with LCPD in their initial or fragmentation stage and can improve the clinical and radiographic outcome of the disease.