This protocol applies to children with juvenile osteochondrosis of the hip and pelvis (LCPD) whose skeletal age is less than 8 years and who demonstrate loss of hip joint containment on radiographic imaging alongside limited hip range of motion.
While most LCPD cases are initially managed nonoperatively, surgical intervention is considered when there is progressive femoral head deformity, persistent range-of-motion limitations, or loss of containment despite conservative measures.
The patient's skeletal age is a key factor: in children under 8, the residual revalgization potential of the proximal femur informs which surgical options are appropriate for restoring and maintaining hip containment.
In this age group and presentation, a bone-corrective surgical procedure targeting the proximal femur is the established first-line intervention, with evidence supporting favorable long-term results worldwide. Depending on the degree of decentration and secondary involvement, additional bony procedures may be incorporated.
DOI: 10.1007/s00402-025-05801-3
While most LCPD cases are initially managed nonoperatively, surgical intervention is considered when there is progressive femoral head deformity, persistent range-of-motion limitations, or loss of containment despite conservative measures.
If the skeletal age is less than 8 years, solely FVO is possible due to the sufficient revalgization potential.
FVO is the first and most preferred surgical treatment for LCPD worldwide and shows favorable long-term results.
In cases of severe decentration and secondary acetabular involvement, the FVO can be combined with a pelvic redirection osteotomy in the sense of 'advanced containment'.
To reduce the chances of these alterations, it is recommended to combine the procedure with trochanter apophyseodesis or distalization and not to exceed a correction of more than 15 degrees varus.
Moderate forms of LCPD show good results when treated with either FVO or SIO.
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