Long-term radiographic outcomes following containment surgery for Legg–Calvé–Perthes disease in the reossification stage

Background This study aimed to evaluate the long-term radiographic outcomes of containment surgery in children with Legg–Calvé–Perthes disease (LCPD) during the reossification stage. Methods This retrospective study included 58 children diagnosed with Waldenström stage III LCPD. Patients were divided into a non-surgical group ( n = 23, mean age 8.56 ± 1.74 years) and a surgical group ( n = 35, mean age 8.28 ± 1.29 years). All patients were monitored with serial anteroposterior pelvic and frog-leg lateral radiographs. At the final follow-up, femoral head morphology was assessed using the modified Stulberg classification, while acetabular development was evaluated using the modified Tönnis angle and the acetabular head index (AHI). Results All 58 patients were followed until skeletal maturity. The mean follow-up duration was 7.15 ± 2.68 years in the non-surgical group and 11.94 ± 5.31 years in the surgical group. At final follow-up, in the surgical group ( n = 35), the simplified three-group modified Stulberg classification showed 34.3% Class I (Excellent; Stulberg I–II), 51.4% Class II (Good; Stulberg III), and 14.3% Class III (Poor; Stulberg IV–V). In the non-surgical group ( n = 23), the corresponding proportions were 17.4%, 43.5%, and 39.1%, respectively. Although a trend toward more favorable outcomes was observed in the surgical group, the difference in the proportion of acceptable outcomes did not reach statistically significant ( P = 0.057, OR = 3.857). However, the surgical group exhibited a significantly smaller modified Tönnis angle (6.12° ± 6.27° vs. 11.63° ± 5.73°, P = 0.002) and a higher AHI (86.98% ± 8.99% vs. 75.51% ± 6.70%, P < 0.001), indicating superior acetabular morphology and coverage. Conclusion Containment surgery performed during the reossification stage of LCPD was associated with significantly better acetabular morphology and coverage and showed a trend toward improved femoral head sphericity. These findings suggest that surgical intervention may be beneficial in select patients with LCPD during this stage of the disease.