In this condition, the upper end of the thigh bone, known as the femoral head, breaks down. As a result, the femoral head is no longer round and does not move easily in the hip socket, which leads to hip pain, limping, and restricted leg movement. The bone eventually begins to heal itself through a normal process called bone remodeling, by which old bone is removed and new bone is created to replace it. This cycle of breakdown and healing can recur multiple times. Affected individuals are often shorter than their peers due to the bone abnormalities. Many people with Legg-Calvé-Perthes disease go on to develop a painful joint disorder called osteoarthritis in the hips at an early age.

Legg-Calvé-Perthes disease.

Background Hip instability has classically been associated with developmental dysplasia of the hip (DDH) in newborns and children. However, numerous factors may contribute to hip instability in children, adolescents, and adults. Purpose This review aims to concisely present the literature on hip instability in patients of all ages in order to guide health care professionals in the appropriate diagnosis and treatment of the various disorders which may contribute to an unstable hip. Methods We reviewed the literature on the diagnosis and surgical management of hip dysplasia and other causes of hip instability. Conclusions Multiple intra- and extra-articular variables may contribute to hip instability, including acetabular bony coverage, femoral torsion, femoroacetabular impingement, and soft tissue laxity. Physical examination and advanced imaging studies are essential to accurately diagnose the pathology contributing to a patient's unstable hip. Conservative management, including activity modification and physical therapy, may be used as a first-line treatment in patients with intra-articular hip pathology. Patients who continue to experience symptoms of pain or instability should proceed with arthroscopic or open surgical treatment aimed at correcting the underlying pathology. Level of evidence V.

/pdf/hip-instability-a-review-of-hip-dysplasia-and-other-1wl243r6bi.pdf

Hip instability: a review of hip dysplasia and other contributing factors

This article presents the results of Legg-Calve-Perthes (LCP) disease treatment using triple pelvic osteotomy. Thirty patients were analysed. The conditions for inclusion in the study were complete medical documentation and follow-up until the disease was resolved. Postoperatively, no patients were immobilised. Rehabilitation was initiated early in all patients, and full weight bearing was allowed after ten weeks. With this method, an increase of the CE angle of 17.43 ± 4.020° was achieved. Containment was increased from an initial 6.67% to 53.33% of patients at the final check-up. Similar improvement was achieved by using Herring classification of the damage; preoperatively most hips belonged to group C, and postoperatively to group A. Postoperatively, functional results were also considerably improved. The authors recommend triple pelvic osteotomy as the method of choice in the treatment of severe cases of LCP disease.

/pdf/triple-pelvic-osteotomy-in-the-treatment-of-legg-calve-36qutyrz77.pdf

Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease

Purpose
Treatment of Legg–Calve-Perthes disease in older children with greater involvement of the femoral head remains uncertain. Innominate, femoral or combined innominate and femoral osteotomies are generally performed to better contain and provide more coverage of the femoral head by the acetabulum with the objective of achieving a more spherical head and a congruent joint. The purpose of the study was to evaluate the radiographic outcomes of simultaneous femoral and pelvic osteotomies.

https://online.boneandjoint.org.uk/doi/pdf/10.1007/s11832-009-0171-z

Radiographic results of combined Salter innominate and femoral osteotomy in Legg–Calvé–Perthes disease in older children

Background
Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calve-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement.

/pdf/triple-innominate-osteotomy-for-legg-calve-perthes-disease-1u5bt6694l.pdf

Triple innominate osteotomy for Legg-Calvé-Perthes disease in children: does the lateral coverage change with time?

The authors reviewed 21 patients who underwent triple pelvic osteotomy for severe Legg-Calve-Perthes disease to evaluate their clinical, functional, and radiologic results. The mean age at presentation was 7 years 7 months (range 5-11 years). Seventeen hips were Herring group C and 5 were group B. All of them had "at risk" radiologic signs. A new technique of interlocking iliac osteotomy was used to provide extra stability, allow early weight bearing, and prevent inadvertent retroversion. The average period of follow-up was 30 months (range 1-5 years). The average gain in Harris score was 34.3 (range 4-55). The average gain in acetabular head index was 18% and that in center-edge angle was 22 degrees, more than reported for any other single surgical procedure for containment of the subluxed femoral head. Average gains in abduction, internal rotation, and flexion were 17 degrees, 12 degrees, and 28 degrees respectively. Longer follow-up is required to see the results at maturity, but the early results are promising.

Interlocking triple pelvic osteotomy in severe Legg-Calvé-Perthes disease.

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Interlocking triple pelvic osteotomy in severe Legg-Calvé-Perthes disease.