A combined treatment strategy of Legg-Calve-Perthes disease with BEST quartet
Abstract
Purpose: The main pathology of Legg-Calvé-Perthes Disease (LCPD) is the disruption of blood flow of the
femoral head resulting ischemic necrosis which leads hip joint incongruency. The most frequent methods in
the treatment are the methods improving the containment of the femoral head. There are limited studies in
the literature addressing the treatment of necrosis using methods such as epiphyseal drilling or distraction
osteogenesis. Our study aimed to investigate the mid-long-term outcomes of LCPD patients treated with the
BEST method, which aims to improve congruency and containment simultaneously.
Materials and methods: LCPD patients (23 male, 1 female) who were treated with (B)leeding the epiphysis
by drilling, (E)vacuation of the joint synovitis, contained with (S)alter’s Osteotomy, and distracted with skin
(T)raction investigated retrospectively. Only patients who reached skeletal maturity at latest follow-up were
included in the study. Patients’ final radiographs were classified according to the Stulberg classification, Mose
classification, and Tönnis osteoarthritis classification.
Results: The mean follow-up of the patients was 10.44±1.35 (8.5-13) years, and the mean age at the last followup
was 17.71±1.73 (15.25-20.83) years. According to the Stulberg classification, 11 (45.8%) of the patients had
a Class-I hip; 6 (25%) a Class-II hips; 3 (12.5%) a class-III hips, 4 (16.7%) a class-IV hips. According to the Mose
classification, 12 (50%) of the patients had good results; 5 (20.8%) had fair results; 7 (29.1%) had poor results.
Conclusion: BEST treatment method for LCPD is a combined procedure which addresses to all pathologies
of disease at the same time. This combined treatment protocol may be preferred for severely affected LCPD
cases who with subluxation especially in higher lateral pillar class that are prone to nonspherical incongruency
Keywords
Legg-Calve-Perthes disease, Salter’s osteotomy, femoral head osteonecrosis
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