Evolution of legg-calvé-perthes disease following proximal femoral varus osteotomy performed in the avascular necrosis stage:A prospective study

Kumar Amerendra Singh, Hitesh Shah, Benjamin Joseph, Alexander Aarvold, Harry K.W. Kim

Research output: Contribution to journalArticle


Purpose This prospective study was undertaken to describe patterns of fragmentation of the femoral epiphysis following a proximal femoral varus osteotomy (PFVO) done during stage I of LCPD and to assess the disease duration and outcome in each pattern. Methods A total of 25 children treated by a PFVO in stage I of LCPD were followed until healing. The MRI Perfusion Index, radiographic changes in the femoral epiphysis, disease duration and the Sphericity Deviation Score (SDS) at healing were documented. The reproducibility of classification of the pattern of fragmentation, estimation of disease duration and SDS were assessed. The duration of the disease and SDS in the patterns of fragmentation were compared. Results Four patterns of fragmentation were noted, namely, typical fragmentation, bypassing fragmentation, abortive fragmentation and atypical fragmentation with horizontal fissuring. The reproducibility of classifying the pattern of fragmentation was moderate (Kappa: 0.48) while the reproducibility of other continuous variables was excellent. The Perfusion Index was less than 50% in every affected hip. The duration of the disease and SDS were lowest in children in whom the stage of fragmentation was bypassed but these differences were not statistically significant. Conclusion Following a proximal femoral osteotomy during stage I of LCPD the fragmentation stage may be bypassed partially or completely and the chances of a good outcome appear to be very good if fragmentation is bypassed.

Original languageEnglish
Pages (from-to)58-67
Number of pages10
JournalJournal of Children's Orthopaedics
Issue number1
Publication statusPublished - 02-2020


All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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