{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:19:15Z","timestamp":1789827555210,"version":"4.0.1"},"reference-count":36,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University Hospital of Muenster, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Legg\u2013Calv\u00e9\u2013Perthes disease (LCPD) presents challenges in treatment due to its varied course and unclear etiology. This study aimed to evaluate the efficacy of combining proximal femoral varus osteotomy (PFVO) with a modified trochanteric flip osteotomy to address biomechanical consequences and improve hip abductor muscle strength. Methods: We present a modified approach combining PFVO with a trochanteric flip osteotomy. In this technique, the greater trochanter in compound with its muscular insertions is separated from the femur and attached distally using a varization blade plate. Nine patients (ten hips, mean age 8 years) with LCPD were treated using this technique. Clinical examination findings and radiographic evaluations were retrospectively analyzed. The median follow-up was 33 months. Results: At the last follow-up, two patients exhibited Trendelenburg gait, but hip abduction was improved in all patients. Radiographically, consolidation at the osteotomy site was observed in all cases with no delayed union or non-union. The median CE angle improved by 7\u00b0, while the median CCD decreased by 18\u00b0. The median MPFA decreased by 13\u00b0, resulting in a median of 82\u00b0. Conclusions: Combining PFVO with a modified trochanteric flip osteotomy addresses biomechanical issues associated with PFVO, potentially improving hip containment and abductor muscle strength. This approach may offer advantages over traditional osteotomy techniques in treating LCPD, and it appears to produce a superior functional outcome in particular in regard to limping when compared to conventional PFVO. Despite satisfactory radiological outcomes in most cases, further research is needed to assess long-term effectiveness and address challenges such as femoral head enlargement and persistent gait abnormalities.<\/jats:p>","DOI":"10.3390\/children12010051","type":"journal-article","created":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T11:24:19Z","timestamp":1735730659000},"page":"51","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modified Trochanteric Flip Osteotomy in Varus Intertrochanteric Osteotomy for Treatment of Legg\u2013Calv\u00e9\u2013Perthes Disease"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5658-2298","authenticated-orcid":false,"given":"Andrea","family":"Laufer","sequence":"first","affiliation":[{"name":"Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany"},{"name":"General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina","family":"Antfang","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany"},{"name":"General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Gosheger","sequence":"additional","affiliation":[{"name":"General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Frommer","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany"},{"name":"General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Toporowski","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany"},{"name":"General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Tretow","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Roedl","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-2751","authenticated-orcid":false,"given":"Bjoern","family":"Vogt","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics, Deformity Reconstruction and Foot Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S141","DOI":"10.1097\/BPO.0b013e318223b4bd","article-title":"Legg-calve-perthes disease: Etiology, pathogenesis, and biology","volume":"31","author":"Kim","year":"2011","journal-title":"J. Pediatr. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.2106\/JBJS.RVW.15.00063","article-title":"The pathogenesis and treatment of legg-calve-perthes disease","volume":"4","author":"Ibrahim","year":"2016","journal-title":"JBJS Rev"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s13023-022-02275-z","article-title":"Legg-calve-perthes disease overview","volume":"17","year":"2022","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.ocl.2011.03.002","article-title":"The epidemiology and etiology of perthes disease","volume":"42","author":"Perry","year":"2011","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.2106\/00004623-200410000-00002","article-title":"Legg-calve-perthes disease. Part ii: Prospective multicenter study of the effect of treatment on outcome","volume":"86","author":"Herring","year":"2004","journal-title":"J. Bone Jt. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s00112-020-00872-5","article-title":"Diagnostik und therapie des morbus perthes","volume":"168","author":"Strobl","year":"2020","journal-title":"Monatsschrift Kinderheilkd."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.ocl.2011.04.008","article-title":"Containment methods for treatment of legg-calve-perthes disease","volume":"42","author":"Price","year":"2011","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/BPO.0b013e3181f5a0de","article-title":"Advanced containment methods for legg-calve-perthes disease: Results of triple pelvic osteotomy","volume":"30","author":"Wenger","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s00064-022-00784-5","article-title":"Triple osteotomy for patients with legg-calve-perthes disease","volume":"34","author":"Ziebarth","year":"2022","journal-title":"Oper. Orthop. Traumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1097\/BPB.0000000000001023","article-title":"Perthes disease: Comparison of two surgical options","volume":"33","author":"Grothaus","year":"2024","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/01202412-200503000-00005","article-title":"Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-c legg-calve-perthes disease","volume":"14","author":"Aksoy","year":"2005","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s00132-019-03737-2","article-title":"Perthes disease-news in diagnostics and treatment","volume":"48","author":"Westhoff","year":"2019","journal-title":"Orthopade"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Maquet, P.G. (1985). Biomechanics of the hip. Biomechanics of the Hip: As Applied to Osteoarthritis and Related Conditions, Springer.","DOI":"10.1007\/978-3-642-50960-5"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/01.blo.0000163474.74168.6f","article-title":"Greater trochanteric transfer for the treatment of coxa brevis","volume":"434","author":"Eilert","year":"2005","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_15","first-page":"38","article-title":"Distal transfer of the greater trochanter in acquired coxa vara. Clinical and radiographic results","volume":"12","author":"Garrido","year":"2003","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1302\/0301-620X.73B5.1894678","article-title":"Distal transfer of the greater trochanter","volume":"73","author":"Macnicol","year":"1991","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_17","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 Jt. Surg. Br."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1302\/0301-620X.47B3.489","article-title":"Subtrochanteric osteotomy in the treatment of perthes\u2019 disease: A preliminary report","volume":"47","author":"Axer","year":"1965","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"341","DOI":"10.2106\/JBJS.J.00830","article-title":"How much varus is optimal with proximal femoral osteotomy to preserve the femoral head in legg-calve-perthes disease?","volume":"93","author":"Kim","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s10195-016-0412-0","article-title":"Short follow-up evaluation of proximal femoral varus osteotomy for treatment of legg-calve-perthes disease","volume":"17","author":"Elzohairy","year":"2016","journal-title":"J. Orthop. Traumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00064-022-00778-3","article-title":"Proximale varisationsosteotomie des femurs beim morbus perthes","volume":"34","author":"Kraus","year":"2022","journal-title":"Oper. Orthop. Traumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00003086-198007000-00004","article-title":"Legg-perthes disease: The scientific basis for the methods of treatment and their indications","volume":"150","author":"Salter","year":"1980","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/01241398-200309000-00006","article-title":"Optimal timing for containment surgery for perthes disease","volume":"23","author":"Joseph","year":"2003","journal-title":"J. Pediatr. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1302\/0301-620X.90B10.20649","article-title":"Prognostic factors and outcome of treatment in perthes\u2019 disease: A prospective study of 368 patients with five-year follow-up","volume":"90","author":"Wiig","year":"2008","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/00003086-198007000-00013","article-title":"Evaluation of femoral osteotomy in the treatment of legg-calve-perthes disease","volume":"150","author":"Heikkinen","year":"1980","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/01241398-199101000-00005","article-title":"Pitfalls in treatment of legg-calve-perthes disease using proximal femoral varus osteotomy","volume":"11","author":"Weiner","year":"1991","journal-title":"J. Pediatr. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1001\/jama.1977.03270420091031","article-title":"Biomechanics of the normal and diseased hip: Theoretical foundation, technique and results of treatment","volume":"237","author":"Cooper","year":"1977","journal-title":"JAMA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s11999-008-0128-4","article-title":"Trochanteric advancement in patients with legg-calv\u00e9-perthes disease does not improve pain or limp","volume":"466","author":"Joo","year":"2008","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1055\/s-2002-33982","article-title":"Einfluss der intertrochant\u00e4ren varisierenden osteotomie beim morbus perthes auf das gangbild von kindern","volume":"214","author":"Follak","year":"2002","journal-title":"Klin. Padiatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1302\/2058-5241.3.160068","article-title":"Impingement around the hip: Beyond cam and pincer","volume":"3","author":"Bech","year":"2018","journal-title":"EFORT Open Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s11832-016-0714-z","article-title":"Epos 35th congress meeting","volume":"10","year":"2016","journal-title":"J. Child. Orthop."},{"key":"ref_32","unstructured":"Kelikian, A.S., Tachdjian, M.O., Askew, M.J., and Jasty, M. (1983). Greater trochanteric advancement of the proximal femur: A clinical and biomechanical study. Hip, 77\u2013105."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11751-014-0186-y","article-title":"Guided growth of the trochanteric apophysis combined with soft tissue release for legg-calve-perthes disease","volume":"9","author":"Stevens","year":"2014","journal-title":"Strateg. Trauma Limb Reconstr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/01241398-198509000-00002","article-title":"Coxa breva: Its pathogenesis and a rationale for its management","volume":"5","author":"Stevens","year":"1985","journal-title":"J. Pediatr. Orthop."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e7723","DOI":"10.1097\/MD.0000000000007723","article-title":"Effect of greater trochanteric epiphysiodesis after femoral varus osteotomy for lateral pillar classification b and b\/c border legg-calve-perthes disease: A retrospective observational study","volume":"96","author":"Kwon","year":"2017","journal-title":"Medicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1097\/BPO.0b013e3181c1e943","article-title":"Effect of prophylactic trochanteric epiphyseodesis in older children with perthes\u2019 disease","volume":"29","author":"Shah","year":"2009","journal-title":"J. Pediatr. Orthop."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/51\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:23:03Z","timestamp":1759850583000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/51"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["children12010051"],"URL":"https:\/\/doi.org\/10.3390\/children12010051","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,1]]}}}