AIM: To compare short-term radiographic outcomes of femoral varus osteotomy (FVO) and Salter innominate osteotomy (SIO) in treating Legg-Calvé-Perthes disease (LCPD) and to identify prognostic factors through multivariate analysis.

METHODS: This retrospective study included 33 pediatric LCPD patients (mean age: 6.80 ± 1.82 years) treated between January 2016 and January 2021, with a mean follow-up of 21.09 ± 10.63 months. Patients were categorized into FVO (n = 20) and SIO (n = 13) groups. Radiographic parameters, including center-edge angle, acetabular index (AI), acetabular head index (AHI), and Sharp angle, were evaluated preoperatively and postoperatively. Hip morphology was assessed using the modified Stulberg classification. Multivariate ordered logistic regression was used to identify predictors of radiographic outcome.

RESULTS: Postoperative AI and AHI differed significantly between the two groups (p < 0.001). Stulberg classification outcomes showed a higher proportion of excellent results in the SIO group (53.84%) compared to the FVO group (40.00%), although the difference was not statistically significant (p = 0.091). Multivariate analysis identified older age and advanced Catterall stage as independent predictors of poorer outcomes (p < 0.05).

CONCLUSIONS: Both surgical approaches demonstrate clinical efficacy in the management of LCPD. However, SIO offers enhanced acetabular remodeling potential. Key prognostic factors include skeletal maturity and the degree of epiphyseal involvement (Catterall stage III/IV), suggesting that early surgical intervention may yield improved outcomes.