Do femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calvé-Perthes disease? A meta-analysis pediatrics

Background: Recently, the authors of two prospective multicenter observational studies recommended surgery to improve head sphericity in older children, whereas large retrospective observational studies suggest that surgery does not improve head sphericity in older children. Thus, the treatment for Legg-Calvé-Perthes disease (LCPD) remains controversial. Questions/purposes: Using a meta-analysis we asked whether femoral varus osteotomy (FVO) or Salter innominate osteotomy (SIO) resulted in better radiographic head sphericity at the end of the disease process as compared with nonsurgical modalities. Methods: We systematically searched the literature using the key concepts LCPD, operative treatment, and nonoperative treatment. Of 160 abstracts, 57 full-text studies were reviewed and 14 papers chosen for meta-analysis. Subgroup analyses were performed to assess the impact of age and stage of disease. The odds of a spherical head after operative compared with nonoperative treatment were calculated to measure effect size for each study and a pooled odds ratio (OR) calculated. Results: Head sphericity improved (OR, 1.29; 95% CI, 1.05-1.60) by FVO or SIO as compared with patients treated nonoperatively. In children younger than 6 years, it did not alter femoral head sphericity (OR, 1.02; 95% CI, 0.45-2.36); children 6 years of age and older were more likely to have better femoral head sphericity from surgical treatment than nonoperative treatment (OR, 2.05; 95% CI, 1.28-3.26). Conclusions: The data suggest FVO or SIO in patients with LCPD disease who are older than 6 years of age during or before the fragmentation phase should be considered. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.