Journal of Pediatric Orthopaedics - 2026-05-11 - Journal Article
Improved Gait and Patient-Reported Outcomes Following Hip Preservation Procedures Via Surgical Hip Dislocation Approach in Adolescents With Residual Legg-Calvé-Perthes Disease.
Chhabra K, Anable N, Kak A, Morris W, Jo C, Sucato DJ, Kim HKW
Topics
Key Takeaway
Hip preservation via surgical hip dislocation in adolescents with residual LCPD improved mHHS from 58.6 to 72.1 and Gait Deviation Index at mean 2-year follow-up, without improvement in Sphericity Deviation Score.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study evaluated gait parameters, PROs, and radiographic outcomes in adolescents with healed-stage LCPD undergoing hip preservation via surgical hip dislocation (SHD). Thirty-nine patients (mean age 16.55 years) underwent preoperative and minimum 1-year postoperative instrumented gait analysis with comparison to healthy age-matched controls. mHHS improved from 58.6 to 72.1 (P=0.0001), UCLA Activity Score from 6.41 to 8.28 (P<0.001), with significant gains in walking speed, stride length, Gait Deviation Index, hip extension, and hip flexion power, but no change in hip abduction function or Sphericity Deviation Score.
Key Limitation
The heterogeneity of concomitant procedures performed at SHD (not individually analyzed) prevents determination of which specific intervention—osteochondroplasty, labral repair, relative neck lengthening, or other—drives the observed gait and PRO improvements.
Original Abstract
BACKGROUND
Adolescent patients with hip dysfunction due to residual deformity in the healed stage of Legg-Calvé-Perthes disease (LCPD) remain a treatment decision-making challenge. Some advocate hip preservation via the surgical hip dislocation (SHD) approach, with concomitant procedures to address various hip pathologies. Currently, hip movement and gait analysis data before and after the SHD approach are lacking. This study aimed to determine the gait parameters, patient-reported outcomes, and radiographic outcomes of adolescent patients with LCPD who had hip preservation procedures via SHD.
METHODS
A retrospective review of a prospectively collected database at a single tertiary referral center was conducted for patients in the healed stage who had hip preservation procedures via SHD. We included patients who had preoperative and a minimum of 1-year postoperative gait analysis. Patient-reported outcomes included the UCLA Activity Score and modified Harris Hip Score (mHHS). Radiographic assessment included Stulberg classification and Sphericity Deviation Score (SDS). Similarly aged healthy controls were used for comparison of gait parameters.
RESULTS
Thirty-nine patients met the inclusion criteria, with a mean age at surgery of 16.55±2.56 years and a mean time point for post-SHD gait analysis of 2.02±0.64 years. There was improvement in the mHHS (preop: 58.59±12.98, postop: 72.12±11.36, P =0.0001) and UCLA Activity Score (preop: 6.41±2.55, postop: 8.28±2.11, P <0.001). Gait analysis revealed improved walking speed ( P =0.02), stride length ( P <0.001), Gait Deviation Index ( P =0.03), maximum degree of hip extension ( P <0.01), and power generated during hip flexion ( P =0.01). Hip abduction function showed no change ( P =0.15). Five hips improved from Stulberg IV to III ( P =0.10). There was no difference in SDS ( P =0.95).
CONCLUSION
Hip-preservation procedures via SHD produced significant improvements in gait parameters and patient-reported outcomes without loss of hip abduction function, but no improvement in SDS. This study provides new insights into how hip-preservation procedures via SHD improve gait and function in adolescent patients with LCPD and residual hip deformity.
LEVEL OF EVIDENCE
Level III retrospective cohort study.