Combined osteotomy as a salvage procedure for severe Legg-Calvé-Perthes disease.

Combined Salter innominate and varus femoral osteotomies were performed on 14 patients with severe Legg-Calvé-Perthes disease. The mean patient age was 8 years 4 months. Nine hips were Catterall class III, five class IV, and all had three or more head-at-risk signs. The average preoperative epiphyseal index was 30%. Mean follow-up was 8 years. Eleven of 14 patients had a good clinical result, and radiographs showed progressive spherical remodeling of the femoral head. Seven hips demonstrated spherical congruency at follow-up. The epiphyseal extrusion index at follow-up was less than 20% in 13 of 14 hips. We conclude that combined osteotomy is a safe and effective salvage procedure in severe Legg-Calvé-Perthes disease.