HipComparison of surgical and nonsurgical containment methods for patients with Legg-Calvé-Perthes disease of the onset ages between 6.0 and 8.0 years: Salter osteotomy versus a non-weight-bearing hip flexion-abduction braceKaneko, Hiroshia; Kitoh, Hiroshib; Mishima, Kenichib; Matsushita, Masakib; Hattori, Tadashia; Noritake, Kojic; Ishiguro, Naokib; Yoshihashi, YujicAuthor Information aDepartment of Orthopaedic Surgery, Aichi Children’s Health and Medical Center, Obu bDepartment of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya cDepartment of Orthopaedic Surgery, Aichi Prefectural Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Aichi, Japan Correspondence to Hiroshi Kaneko, MD, PhD, Department of Orthopaedic Surgery, Aichi Children’s Health and Medical Center, 7-426 Moriokacho, Obu, Aichi 474-8710, Japan, Tel: +81 562 43 0500; fax: +81 562 43 0513; e-mail: firstname.lastname@example.org Journal of Pediatric Orthopaedics B: November 2020 - Volume 29 - Issue 6 - p 542-549 doi: 10.1097/BPB.0000000000000710 Buy Metrics Abstract Since bone healing potential decreases with age, patients with Legg-Calvé-Perthes disease should receive treatment appropriate to their age group. Nonsurgical treatment is commonly applied to patients under 6.0 years of age at the onset and surgical treatment is recommended for those over 8.0 years of age, but it remains unclear which is better for those between 6.0 and 8.0 years. The aim of this retrospective study was to compare outcomes of Salter osteotomy and a non-weight-bearing brace in this age group. Inclusion criteria were unilateral Legg-Calvé-Perthes disease patients who were 6.0–8.0 years of age at the onset, who had more than 50% femoral head involvement without hinge abduction, and who underwent either Salter osteotomy (n = 35) or a non-weight-bearing hip flexion-abduction brace (n = 18). Radiological and clinical outcomes at skeletal maturity were compared between the two groups. The mean follow-up durations were 9.4 years in the Salter osteotomy group and 10.0 years in the brace group. There was no significant difference in the modified Waldenström classification at the beginning of treatment and the Catterall and modified lateral pillar classifications evaluated at the fragmentation stage between the groups. At skeletal maturity, the Stulberg classification, the sphericity deviation score, femoral head overgrowth, and the articulo-trochanteric distance were similar between the groups, but the Salter osteotomy group showed significantly smaller lateralization of the femoral head and better acetabular shape and coverage than the brace group: femoral head lateralization (P < 0.001), acetabular depth-to-width ratio (P = 0.002), Sharp angle (P < 0.001), lateral acetabular shape (P = 0.027), acetabular head index (P < 0.001). There was no significant difference in hip pain and motion between the groups. In this age group, Salter osteotomy provides better femoral head position and acetabular shape and coverage than a non-weight-bearing brace. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.