Varus Derotational Osteotomy as Treatment of Legg-Calvé-Perthes Disease

Containment of the femoral head in a more covered position has been theorized to offset disease progression, providing more favorable remodeling potential. The first femoral osteotomy was developed as a less restricted method of treatment yielding better results than abduction braces. The goal of a varus derotational osteotomy (VDRO) is to bypass the fragmentation stage through containment of the femoral head. The best results occur with early intervention, when the osteotomy is performed during the stage of avascular necrosis or in the early part of the fragmentation stage. A postoperative angle of varus inclination greater than 105 degrees and trochanter epiphysiodesis during initial surgery have shown less association with long-term problems. Positioning the femoral head in a more covered position provides theoretical benefits in accelerated healing, decrease in fragmentation of the epiphysis, and potential change in the vascular supply.