Ganz femoral head reduction associated with coverage and containment procedures improve radiographic and functional outcomes in Legg-Calvè-Perthes disease

Objective: The pioneering research conducted by Ganz has significantly advanced the treatment options for managing joint deformities affecting both the femoral and acetabular aspects in patients diagnosed with Legg-Calvé-Perthes disease. The central objective of this study is to provide an in-depth assessment of the clinical and morphological outcomes achieved through the surgical intervention known as femoral head reduction osteotomy when combined with periacetabular osteotomy. This study presents an innovative and integrated approach to surgical planning that aims to optimize patient outcomes. Methods: The study spanned from 2015 to 2023, during which 13 FHRO procedures were performed on a cohort of 11 patients diagnosed with LCPD across two distinct medical centers. Among these 13 procedures, 11 were conducted concurrently with PAO. A specialized and meticulously designed protocol was employed, utilizing computed tomography (CT) and magnetic resonance imaging (MRI) to facilitate virtual correction simulations. The comprehensive assessment of outcomes included a thorough evaluation of radiographic parameters, encompassing the sphericity index, extrusion index, integrity of Shenton's line, LCE angle, Tonnis angle, and CCD angle. Furthermore, clinical parameters were assessed, which included evaluating range of motion (ROM), measuring pain levels using the visual analog scale (VAS), applying the Merle d'Aubigné-Postel score, calculating the modified Harris Hip Score (HHS), and employing the EQ-5D-5L questionnaire to gauge overall quality of life. The study also meticulously documented early and late complications during treatment. Results: The study's average follow-up duration extended to 40 months, with patients undergoing surgery at an average age of 11.4 years. Notably, no significant complications of clinical significance were recorded throughout the study duration. The outcomes of this comprehensive assessment yielded several notable improvements in a variety of critical parameters: Femoral Head Sphericity demonstrated a remarkable increase from an initial measurement of 46.8% to a post-operative measurement of 70.2% (p < 0.001). LCE angle substantially improved, rising from 19.2° to 44° (p < 0.001). The extrusion index significantly decreased from an initial reading of 37.8 to 8.5 (p < 0.001). In terms of the Tonnis angle, although a statistical trend was observed, it did not reach significance, changing from 13.8° to 5.9° (p = 0.1); the CCD angle demonstrated a notable increase from 130.6° to 136° (p = 0.09). In assessing the VAS score, it improved significantly, decreasing from an initial score of 3.55 to 1.22 (p = 0.06). Additionally, the Merle d'Aubigné- Postel score exhibited an enhancement, increasing from 14.55 to 16 (p = 0.01), and the Modified HHS improved from 60.6 to 81 (p = 0.02). Conclusion: This study underscores the safety and efficacy of combining FHRO with periacetabular procedures, ultimately improving functional, clinical, and morphological outcomes in patients diagnosed with LCPD. The introduction of a novel simulation and planning algorithm is of particular significance, which not only adds an innovative dimension to surgical planning but also holds substantial potential for further refinement of this surgical technique. The findings from this study provide valuable insights for orthopedic surgeons and researchers aiming to optimize the management of joint deformities associated with LCPD.