Lateral shelf acetabuloplasty for severe Legg–Calvé–Perthes disease in patients older than 8 years
نویسندگان
چکیده
The natural history of Legg-Calvé-Perthes disease (LCPD) in children older than 8 years is usually poor without treatment. The treatment goal is to prevent deformity and incongruity of the hip by achieving a stable spherical femoral head in a deep, congruent, sharp-edged acetabulum, with a good range of hip movement at skeletal maturity. Lateral shelf acetabuloplasty in LCPD can increase the coverage of the femoral head, benefiting the remodeling of the femoral head and acetabulum. The aim of this study was to evaluate the efficacy of lateral shelf acetabuloplasty for severe LCPD in patients older than 8 years.We evaluated 51 patients with severe LCPD who underwent shelf acetabuloplasty between 1994 and 2005. Clinical and radiological examinations were evaluated preoperatively and over a mean follow-up of 132.35 months (range 102-183 months). According to the Catterall classification, the LCPD was classified as grade II in 11 (21.6%) patients, grade III in 15 (29.4%), and grade IV in 25 (49.0%). According to the Herring classification, there were 12 (23.5%) patients in grade B, 24 (47.1%) in grade B/C, and 15 (29.4%) in grade C. The mean ages at the onset of signs and at surgery were 103.39 months and 110.78 months, respectively.By the end of follow-up, all patients had a normal passive range of hip movement without pain. The mean Iowa hip score was improved from 69.5 ± 7.28 to 91.6 ± 5.14 (P < 0.001). According to the Stulberg classification, 11 (21.6%) hips were classified as grade 1, 19 (37.3%) hips as grade 2, 14 (27.5%) hips as grade 3, and 7 (13.7%) hips as grade 4. The CE angle, Sharp angle, medial joint space ratio, epiphysis height ratio, and percentage of acetabular coverage were significantly improved by shelf acetabuloplasty (P < 0.001).We recommend shelf acetabuloplasty for severe LCPD in patients older than 8 years. The procedure yields a favorable clinical outcome and Stulberg outcome for the hip. Shelf acetabuloplasty can improve femoral head coverage and reduce subluxation of the hip, with a benefit to the biological remodeling of the femoral head within the acetabulum.
منابع مشابه
Shelf Acetabuloplasty in the Treatment of Severe Legg-Calvé-Perthes Disease: Good Outcomes at Midterm Follow-Up
The aim of the study was to retrospectively review results of operative treatment for coverage deficit of femoral head in children with severe epiphysis displacement in Legg-Calvé-Perthes (LCP) disease. The material included 23 shelf acetabuloplasty procedures for LCP disease. The average age at diagnosis was 8.1 years (range 4-12). Mean follow-up was 5.8 years (range from 2.2 to 11.2 years). M...
متن کاملOutcomes of Combined Shelf Acetabuloplasty with Femoral Varus Osteotomy in Severe Legg-Calve-Perthes (LCP) Disease: Advanced Containment Method for Severe LCP Disease
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 v...
متن کاملEvolution in diagnosis and treatment of Legg-Calve-Perthes disease
Legg-Calvé-Perthes disease (LCPD) is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which i...
متن کاملShelf acetabuloplasty for Perthes' disease: 12-year follow-up.
The goal of all therapies for Perthes' disease is to achieve an optimal shape of the acetabulum and an optimal coverage of the femoral head. Thirty patients who were included in this follow-up study (mean follow-up 12 years) underwent a shelf acetabuloplasty for Catterall group III or IV. The mean IOWA hip score at follow-up was 96 (max. 100 points, range 74-100). The mean acetabular-head quoti...
متن کاملLateral shelf acetabuloplasty in Perthes' disease. A review of the end of growth.
The surgical treatment of Perthes' disease by femoral or innominate osteotomy is not as effective in those over the age of eight years as it is in the younger child. This has prompted the search for other types of management in those who are older. The preliminary results of the use of a lateral shelf acetabuloplasty for such cases have shown encouraging results at two years. The concern with s...
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عنوان ژورنال:
دوره 95 شماره
صفحات -
تاریخ انتشار 2016