Clin Orthop Surg.  2015 Dec;7(4):497-504. 10.4055/cios.2015.7.4.497.

Outcomes of Combined Shelf Acetabuloplasty with Femoral Varus Osteotomy in Severe Legg-Calve-Perthes (LCP) Disease: Advanced Containment Method for Severe LCP Disease

Affiliations
  • 1Upper Extremity and Microsurgery Center, Semyeong Christianity Hospital, Pohang, Korea.
  • 2Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jss3505@skku.edu

Abstract

BACKGROUND
Standard treatments may provide adequate containment in mild to moderate Legg-Calve-Perthes disease (LCPD), but they can be problematic in more severe cases. The purpose of this study was to report the results of combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD.
METHODS
We reviewed 12 patients who had undergone combined shelf acetabuloplasty with femoral varus osteotomy. The indications for this type of operation were: (1) above 8 years of age at clinical onset; (2) massive femoral epiphysis involvement (Catterall group 4, lateral pillar C); (3) femoral head lateral subluxation on the anteroposterior radiograph; and (4) impending hinged abduction on preoperative magnetic resonance imaging or arthrography. The mean age was 9.3 years (range, 8 to 10.8 years). The patients were clinically evaluated with Iowa hip score and leg length discrepancy at the final follow-up. Radiographic outcome was assessed using the Stulberg classification to evaluate femoral head sphericity. The presence of osteoarthritis was evaluated by the Tonnis classification. Correlation analysis was conducted to analyze the preoperative factors that were strongly associated with patients' outcomes.
RESULTS
The mean follow-up period was 10.1 years (range, 7.1 to 13.2 years). Functional grade was excellent in all patients at last follow-up (mean, 92; range, 82 to 99). The mean leg length discrepancy after skeletal maturity was 0.9 cm (range, 0 to 1.7 cm). There were no significant complications or need for additional surgery. Radiographically, 92% of patients reached satisfactory outcomes: Stulberg grade I, 0 cases; Stulberg grade II, 4 cases (34%); Stulberg III, 7 cases (58%), Stulberg IV, 1 case (8%); and Stulberg V, 0 cases. There was no osteoarthritis by Tonnis classification.
CONCLUSIONS
The surgical outcomes for combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD patients over 8 years old are comparable with other advanced surgical methods. In the cases of severe disease that match our inclusion criteria, our containment method could be another treatment option.

Keyword

Legg-Calve-Perthes; Surgical containment; Shelf acetabuloplasty

MeSH Terms

Acetabuloplasty/adverse effects/*methods
Child
Female
Humans
Leg Length Inequality
Legg-Calve-Perthes Disease/radiography/*surgery
Male
Osteotomy/adverse effects/*methods
Pain
Postoperative Complications
Retrospective Studies
Treatment Outcome

Figure

  • Fig. 1 A 9.8-year-old boy with severe Legg-Calve-Perthes disease. (A) Preoperative plain radiograph and magnetic resonance imaging show marked lateral extrusion and extensive collapse of the femoral head. (B) Arthrogram of the patient shows upward migration (arrowhead) of labrum tip due to lateral hump formation of subluxed femoral head. (C) Dynamic arthrogram of the patient shows reduction of femoral head by hip joint abduction, however lateral coverage of enlarged femoral head is insufficient. (D) We performed simultaneous combined proximal femoral varus osteotomy and shelf acetabuloplasty as a means of surgical containment for this patient. (E) Radiograph at 10 years after surgery shows a femoral head that, although not spherical, is congruent and well contained.


Reference

1. Nguyen NA, Klein G, Dogbey G, McCourt JB, Mehlman CT. Operative versus nonoperative treatments for Legg-Calve-Perthes disease: a meta-analysis. J Pediatr Orthop. 2012; 32(7):697–705.
2. Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. 2008; 90(10):1364–1371.
3. Grzegorzewski A, Synder M, Kozlowski P, Szymczak W, Bowen RJ. The role of the acetabulum in Perthes disease. J Pediatr Orthop. 2006; 26(3):316–321.
Article
4. Kim HK, Herring JA. Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am. 2011; 42(3):285–295.
Article
5. Beer Y, Smorgick Y, Oron A, et al. Long-term results of proximal femoral osteotomy in Legg-Calve-Perthes disease. J Pediatr Orthop. 2008; 28(8):819–824.
Article
6. Thompson GH. Salter osteotomy in Legg-Calve-Perthes disease. J Pediatr Orthop. 2011; 31:2 Suppl. S192–S197.
7. Waldenstrom H. The first stages of coxa plana. J Bone Joint Surg Am. 1938; 20(3):559–566.
Article
8. Rab GT. Theoretical study of subluxation in early Legg-Calve-Perthes disease. J Pediatr Orthop. 2005; 25(6):728–733.
9. Chang JH, Kuo KN, Huang SC. Outcomes in advanced Legg-Calve-Perthes disease treated with the Staheli procedure. J Surg Res. 2011; 168(2):237–242.
Article
10. Wenger DR, Pandya NK. Advanced containment methods for the treatment of Perthes disease: Salter plus varus osteotomy and triple pelvic osteotomy. J Pediatr Orthop. 2011; 31:2 Suppl. S198–S205.
11. Kim HK, da Cunha AM, Browne R, Kim HT, Herring JA. How much varus is optimal with proximal femoral osteotomy to preserve the femoral head in Legg-Calve-Perthes disease. J Bone Joint Surg Am. 2011; 93(4):341–347.
Article
12. Staheli LT. Slotted acetabular augmentation. J Pediatr Orthop. 1981; 1(3):321–327.
Article
13. Catterall A. Natural history, classification, and x-ray signs in Legg-Calve-Perthes' disease. Acta Orthop Belg. 1980; 46(4):346–351.
14. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. 2004; 86(10):2103–2120.
15. Green NE, Beauchamp RD, Griffin PP. Epiphyseal extrusion as a prognostic index in Legg-Calve-Perthes disease. J Bone Joint Surg Am. 1981; 63(6):900–905.
16. Larson CB. Rating scale for hip disabilities. Clin Orthop Relat Res. 1963; 31:85–93.
Article
17. Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calve-Perthes disease. J Bone Joint Surg Am. 1981; 63(7):1095–1108.
18. Tonnis D. Congenital dysplasia and dislocation of the hip in children and adults. Berlin, Germany: Springer-Verlag;1987. p. 167.
19. Crutcher JP, Staheli LT. Combined osteotomy as a salvage procedure for severe Legg-Calve-Perthes disease. J Pediatr Orthop. 1992; 12(2):151–156.
Article
20. Ishida A, Kuwajima SS, Laredo Filho J, Milani C. Salter innominate osteotomy in the treatment of severe Legg-Calve-Perthes disease: clinical and radiographic results in 32 patients (37 hips) at skeletal maturity. J Pediatr Orthop. 2004; 24(3):257–264.
Article
21. Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM. Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C Legg-Calve-Perthes disease. J Pediatr Orthop B. 2005; 14(2):88–91.
22. Javid M, Wedge JH. Radiographic results of combined Salter innominate and femoral osteotomy in Legg-Calve-Perthes disease in older children. J Child Orthop. 2009; 3(3):229–234.
Article
23. Wenger DR, Pring ME, Hosalkar HS, Caltoum CB, Lalonde FD, Bastrom TP. Advanced containment methods for Legg-Calve-Perthes disease: results of triple pelvic osteotomy. J Pediatr Orthop. 2010; 30(8):749–757.
24. Terjesen T, Wiig O, Svenningsen S. Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calve-Perthes disease. Clin Orthop Relat Res. 2012; 470(9):2394–2401.
Article
25. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am. 2004; 86(10):2121–2134.
26. Olney BW, Asher MA. Combined innominate and femoral osteotomy for the treatment of severe Legg-Calve-Perthes disease. J Pediatr Orthop. 1985; 5(6):645–651.
Article
27. Vukasinovic Z, Spasovski D, Vucetic C, Cobeljic G, Zivkovic Z, Matanovic D. Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease. Int Orthop. 2009; 33(5):1377–1383.
Article
28. Poul J, Vejrostova M. Triple osteotomy of the pelvis in children and adolescents. Acta Chir Orthop Traumatol Cech. 2001; 68(2):93–98.
29. Salter RB. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip. J Bone Joint Surg Br. 1961; 43(3):518–539.
Article
30. Kruse RW, Guille JT, Bowen JR. Shelf arthroplasty in patients who have Legg-Calve-Perthes disease: a study of long-term results. J Bone Joint Surg Am. 1991; 73(9):1338–1347.
Article
31. Freeman RT, Wainwright AM, Theologis TN, Benson MK. The outcome of patients with hinge abduction in severe Perthes disease treated by shelf acetabuloplasty. J Pediatr Orthop. 2008; 28(6):619–625.
Article
32. Ghanem I, Haddad E, Haidar R, et al. Lateral shelf acetabuloplasty in the treatment of Legg-Calve-Perthes disease: improving mid-term outcome in severely deformed hips. J Child Orthop. 2010; 4(1):13–20.
Article
33. Choi IH, Yoo WJ, Cho TJ, Moon HJ. Principles of treatment in late stages of Perthes disease. Orthop Clin North Am. 2011; 42(3):341–348.
Article
34. Daly K, Bruce C, Catterall A. Lateral shelf acetabuloplasty in Perthes' disease: a review of the end of growth. J Bone Joint Surg Br. 1999; 81(3):380–384.
35. Yoo WJ, Choi IH, Cho TJ, Chung CY, Shin YW, Shin SJ. Shelf acetabuloplasty for children with Perthes' disease and reducible subluxation of the hip: prognostic factors related to hip remodelling. J Bone Joint Surg Br. 2009; 91(10):1383–1387.
36. Domzalski ME, Glutting J, Bowen JR, Littleton AG. Lateral acetabular growth stimulation following a labral support procedure in Legg-Calve-Perthes disease. J Bone Joint Surg Am. 2006; 88(7):1458–1466.
Article
Full Text Links
  • CIOS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr