{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:26Z","timestamp":1787755646707,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,5,4]]},"abstract":"\n Update<\/jats:title>\n This article was updated on May 27, 2022, because of an incorrect URL for the Disclosure of Potential Conflicts of Interest on page 780.<\/jats:p>\n An erratum has been published: J Bone Joint Surg Am. 2022 Jul 6;104(13):e61.<\/jats:p>\n <\/jats:sec>\n \n Background:<\/jats:title>\n Residual Legg-Calv\u00e9-Perthes (LCP) deformities represent one of the most challenging disorders in hip reconstructive surgery. In complex cases, both instability (acetabular dysplasia) and multifocal femoroacetabular impingement (FAI) (proximal femoral deformities) require correction. We assessed intermediate-term patient-reported outcome measures, radiographic correction, complications, and survivorship for combined surgical dislocation (SD) and periacetabular osteotomy (PAO) for the treatment of complex LCP deformities.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A retrospective cohort study was performed on 31 hips with complex LCP deformities undergoing combined SD and PAO for concurrent instability and FAI. Treatment included femoral head reshaping, trochanteric advancement and relative femoral neck lengthening, management of intra-articular lesions, and PAO. Twenty-seven hips (87%) had a minimum follow-up of 5 years. The mean age was 19.8 years, 56% of patients were female, and 44% of patients had undergone a previous surgical procedure.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n At a mean of 8.4 years, 85% of hips (23 of 27) remained preserved (no conversion to total hip arthroplasty). The survivorship estimates were 93% at 5 years and 85% at 10 years. The median (and interquartile range) increased from 64 points (55, 67 points) to 92 points (70, 97 points) (p < 0.001) for the modified Harris hip score (mHHS) and from 60 points (45, 75 points) to 86 points (75, 100 points) (p = 0.001) for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score. Symptoms (mHHS < 70 points) were reported for an additional 19% of hips (n = 5) at the final follow-up. The University of California Los Angeles (UCLA) activity score increased from a median of 8 points (6, 10 points) to 9 points (7, 10 points) (p = 0.207). Structural correction included mean improvement (and standard deviation) of 15.3\u00b0 \u00b1 7.6\u00b0 for acetabular inclination, 20.7\u00b0 \u00b1 10.8\u00b0 for the lateral center-edge angle, 23.4\u00b0 \u00b1 16.3\u00b0 for the anterior center-edge angle, and 18 \u00b1 10 mm for trochanteric height (p < 0.001 for all). Complications occurred in 2 hips (7%), including 1 deep wound infection and 1 superficial wound infection. There was 1 reoperation due to complication, but there were no nerve palsies, thromboembolic events, fractures, or nonunions.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n At an intermediate follow-up of combined SD and PAO for complex LCP deformities, 85% of hips were preserved. This procedure provides reliable deformity correction, major pain relief, improved function, and acceptable complication and failure rates.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Therapeutic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.21.00132","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T14:16:34Z","timestamp":1645625794000},"page":"780-789","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Combined Surgical Dislocation and Periacetabular Osteotomy for Complex Residual Legg-Calv\u00e9-Perthes Deformities"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7582-1415","authenticated-orcid":false,"given":"Jeffrey J.","family":"Nepple","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3026-7502","authenticated-orcid":false,"given":"Serena","family":"Freiman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3549-4998","authenticated-orcid":false,"given":"Gail","family":"Pashos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9041-0203","authenticated-orcid":false,"given":"Tanner","family":"Thornton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9122-1228","authenticated-orcid":false,"given":"Perry L.","family":"Schoenecker","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7040-616X","authenticated-orcid":false,"given":"John C.","family":"Clohisy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,2,23]]},"reference":[{"key":"bib1-20250430","first-page":"119","article-title":"Osteoarthritis of the young adult hip: etiology and treatment","volume":"35","author":"Aronson","year":"1986","journal-title":"Instr Course Lect."},{"issue":"6","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"860","DOI":"10.2106\/00004623-198466060-00006","article-title":"A long-term follow-up of Legg-Calv\u00e9-Perthes disease","volume":"66","author":"McAndrew","year":"1984","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1097\/01241398-199305000-00002","article-title":"Anterior impingement of the femoral head: a late phenomenon of Legg-Calv\u00e9-Perthes\u2019 disease","volume":"13","author":"Snow","year":"1993","journal-title":"J Pediatr Orthop."},{"issue":"7","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.2106\/00004623-198163070-00006","article-title":"The natural history of Legg-Calv\u00e9-Perthes disease","volume":"63","author":"Stulberg","year":"1981","journal-title":"J Bone Joint Surg Am."},{"key":"bib5-20250430","first-page":"20","article-title":"Etiology of osteoarthritis of the hip","author":"Harris","year":"1986","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1007\/s11999-014-4115-7","article-title":"Does surgical hip dislocation and periacetabular osteotomy improve pain in patients with Perthes-like deformities and acetabular dysplasia?","volume":"473","author":"Clohisy","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib7-20250430","first-page":"273","article-title":"Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes\u2019 disease","volume":"16","author":"Eijer","year":"2006","journal-title":"Hip Int."},{"issue":"12","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"3168","DOI":"10.1007\/s11999-010-1489-z","article-title":"Algorithm for femoral and periacetabular osteotomies in complex hip deformities","volume":"468","author":"Ganz","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.2106\/00004623-200410000-00001","article-title":"Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications","volume":"86","author":"Herring","year":"2004","journal-title":"J Bone Joint Surg Am."},{"key":"bib10-20250430","first-page":"32","article-title":"Legg-Perthes disease; a method for the measurement of the roentgenographic result","author":"Heyman","year":"1950","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1302\/0301-620X.71B5.2584244","article-title":"Morphological changes in the acetabulum in Perthes\u2019 disease","volume":"71","author":"Joseph","year":"1989","journal-title":"J Bone Joint Surg Br."},{"issue":"3","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1097\/01241398-199205000-00006","article-title":"Acetabular remodelling in Perthes\u2019 disease after primary healing","volume":"12","author":"Kamegaya","year":"1992","journal-title":"J Pediatr Orthop."},{"issue":"11","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"2968","DOI":"10.1007\/s11999-012-2375-7","article-title":"Intraarticular abnormalities in residual Perthes and Perthes-like hip deformities","volume":"470","author":"Ross","year":"2012","journal-title":"Clin Orthop Relat Res."},{"key":"bib15-20250430","first-page":"7","article-title":"Studies on dysplastic acetabula and congenital subluxation of the hip joint","volume":"58","author":"Wiberg","year":"1939","journal-title":"Acta Chir Scand Suppl."},{"issue":"9","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1007\/s11999-012-2345-0","article-title":"Joint-preserving surgery improves pain, range of motion, and abductor strength after Legg-Calv\u00e9-Perthes disease","volume":"470","author":"Albers","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1007\/s11999-014-4032-9","article-title":"Relative femoral neck lengthening improves pain and hip function in proximal femoral deformities with a high-riding trochanter","volume":"473","author":"Albers","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.2106\/JBJS.H.00066","article-title":"Staged surgical dislocation and redirectional periacetabular osteotomy: a report of five cases","volume":"91","author":"Anderson","year":"2009","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1097\/BPO.0b013e3181fcbaaf","article-title":"Sequelae of Perthes disease: treatment with surgical hip dislocation and relative femoral neck lengthening","volume":"30","author":"Anderson","year":"2010","journal-title":"J Pediatr Orthop."},{"issue":"7","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.2106\/00004623-200707000-00002","article-title":"Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities","volume":"89","author":"Clohisy","year":"2007","journal-title":"J Bone Joint Surg Am."},{"key":"bib21-20250430","first-page":"102","article-title":"The periacetabular osteotomy in Legg-Perthes-like deformities","volume":"8","author":"Beck","year":"1997","journal-title":"Semin Arthroplasty."},{"issue":"9","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1007\/s11999-011-2187-1","article-title":"Low early failure rates using a surgical dislocation approach in healed Legg-Calv\u00e9-Perthes disease","volume":"470","author":"Shore","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1302\/0301-620X.83B8.0831119","article-title":"Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis","volume":"83","author":"Ganz","year":"2001","journal-title":"J Bone Joint Surg Br."},{"key":"bib24-20250430","first-page":"241","article-title":"Extended retinacular soft-tissue flap for intra-articular hip surgery: surgical technique, indications, and results of application","volume":"58","author":"Ganz","year":"2009","journal-title":"Instr Course Lect."},{"issue":"8","key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.2106\/00004623-200608000-00007","article-title":"Treatment of femoro-acetabular impingement with surgical dislocation and d\u00e9bridement in young adults","volume":"88","author":"Peters","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1007\/s11999-008-0591-y","article-title":"Surgical dislocation in the management of pediatric and adolescent hip deformity","volume":"467","author":"Rebello","year":"2009","journal-title":"Clin Orthop Relat Res."},{"key":"bib27-20250430","first-page":"26","article-title":"A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results","author":"Ganz","year":"1988","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"bib28-20250430","doi-asserted-by":"crossref","first-page":"3439","DOI":"10.1007\/s11999-012-2507-0","article-title":"What are the factors associated with acetabular correction in Perthes-like hip deformities?","volume":"470","author":"Clohisy","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"254","DOI":"10.2106\/JBJS.D.02093","article-title":"Periacetabular osteotomy for the treatment of severe acetabular dysplasia","volume":"87","author":"Clohisy","year":"2005","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2106\/JBJS.15.00798","article-title":"Patient-reported outcomes of periacetabular osteotomy from the prospective ANCHOR cohort study","volume":"99","author":"Clohisy","year":"2017","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib32-20250430","doi-asserted-by":"crossref","first-page":"2523","DOI":"10.1007\/s11999-013-3015-6","article-title":"Why do hip arthroscopy procedures fail?","volume":"471","author":"Bogunovic","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib33-20250430","first-page":"261","article-title":"[A new measurement method for the radiographic assessment of the proximal femur: the center-trochanter distance]","volume":"38","author":"Omero\u011flu","year":"2004","journal-title":"Acta Orthop Traumatol Turc."},{"issue":"9","key":"bib34-20250430","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.2106\/00004623-199909000-00002","article-title":"Stulberg classification system for evaluation of Legg-Calv\u00e9-Perthes disease: intra-rater and inter-rater reliability","volume":"81","author":"Neyt","year":"1999","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib35-20250430","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1016\/j.arth.2021.02.031","article-title":"Total hip arthroplasty in patients with osteoarthritis associated with Legg-Calve-Perthes disease: perioperative complications and patient-reported outcomes","volume":"36","author":"Anthony","year":"2021","journal-title":"J Arthroplasty."},{"issue":"8","key":"bib36-20250430","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1007\/s11999-009-0842-6","article-title":"St John L, Schoenecker PL, Wright RW. Periacetabular osteotomy: a systematic literature review","volume":"467","author":"Clohisy","year":"2009","journal-title":"Clin Orthop Relat Res."}],"updated-by":[{"DOI":"10.2106\/jbjs.er.21.00132","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000}}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:46:27Z","timestamp":1787751987000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00132"}},"subtitle":["Intermediate-Term Outcomes"],"short-title":[],"issued":{"date-parts":[[2022,2,23]]},"references-count":34,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.21.00132","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,23]]}}}