Head Reduction Osteotomy With Additional Containment Surgery Improves Sphericity and Containment and Reduces Pain in Legg-Calvé-Perthes Disease

Abstract

Background Severe femoral head deformities in the frontal plane such as hips with Legg-Calvé-Perthes disease (LCPD) are not contained by the acetabulum and result in hinged abduction and impingement. These rare deformities cannot be addressed by resection, which would endanger head vascularity. Femoral head reduction osteotomy allows for reshaping of the femoral head with the goal of improving head sphericity, containment, and hip function. Questions/purposes Among hips with severe asphericity of the femoral head, does femoral head reduction osteotomy result in (1) improved head sphericity and containment; (2) pain relief and improved hip function; and (3) subsequent reoperations or complications? Methods Over a 10-year period, we performed femoral head reduction osteotomies in 11 patients (11 hips) with severe head asphericities resulting from LCPD (10 hips) or disturbance of epiphyseal perfusion after conservative treatment of developmental dysplasia (one hip). Five of 11 hips had concomitant acetabular containment surgery including two triple osteotomies, two periacetabular osteotomies (PAOs), and one Colonna procedure. Patients were reviewed at a mean of 5 years (range, 1-10 years), and none was lost to followup. Mean patient age at the time of head reduction osteotomy was 13 years (range, 7-23 years). We obtained the sphericity index (defined as the ratio of the minor to the major axis of the ellipse drawn to best fit the femoral head articular surface on conventional anteroposterior pelvic radiographs) to assess head sphericity. Containment was assessed evaluating the proportion of patients with an intact Shenton's line, the extrusion index, and the lateral center-edge (LCE) angle. Merle d'Aubigné-Postel score and range of motion (flexion, internal/external rotation in 90°of flexion) were assessed to measure pain and function. Complications and reoperations were identified by chart review. Results At latest followup, femoral head sphericity (72%; range, 64%-81% preoperatively versus 85%; range, 73%-96% postoperatively; p = 0.004), extrusion index (47%; range, 25%-60% versus 20%; range, 3%-58%; p = 0.006), and LCE angle (1°; range, À10°to 16°versus 26°; range, 4°-40°; p = 0.0064) were improved compared with preoperatively. With the limited number of hips available, the proportion of an intact Shenton's line (64% versus 100%; p = 0.087) and the overall Merle d'Aubigné-Postel score (14.5; range, 12-16 versus 15.7; range, 12-18;

Femoral head reduction osteoplasty for fracture dislocation: A surgical technique

“…He reported excellent results, with only one patient developing AVN with fragmentation. A recent series by Siebenrock of eleven patients with similar pathology at 5 year follow up demonstrated improved femoral head sphericity and congruency and better pain scores in 11 patients with no AVN [31]. All series reported 100% healing of the femoral head osteotomy.…”

Computer-assisted femoral head reduction osteotomies an approach for anatomic reconstruction of severely deformed Legg-Calvè-Perthes hips

“…The radiological outcome was measured by two independant readers on pre-and postoperative pelvic AP radiographs. (19) For the evaluation of the head shape the femur head diameter in ratio to the healthy contralateral side(10), the sphericity index (ratio of the minor and major axis of the ellipsoid femoral head) (19)…”

“…Femoral head reduction osteotomy remains as the only joint-preserving surgical treatment option. (1,6,8,(18)(19)(20) Ganz performed the rst FHRO in 2002 and published it in 2009 [ Fig. 2] (1).…”

Brief concept of hip preservation

“…Интракапсулярные (трансцервикальные и суб-капитальные) остеотомии шейки бедра помогут скорректировать серьезные деформации в слу-чае соскальзывания верхнего эпифиза бедренной кости (СВЭБК), остановки роста проксимальной части бедренной кости и асептического некро за [5,10,11]. Риск асептического некроза головки бедренной кости при интракапсулярной остео-томии был существенно снижен за счет исполь-зования методики безопасной хирургической дислокации Ганца, основанной на детальной оценке крово снабжения головки бедренной ко-сти [10,11].…”

“…Интракапсулярные (трансцервикальные и суб-капитальные) остеотомии шейки бедра помогут скорректировать серьезные деформации в слу-чае соскальзывания верхнего эпифиза бедренной кости (СВЭБК), остановки роста проксимальной части бедренной кости и асептического некро за [5,10,11]. Риск асептического некроза головки бедренной кости при интракапсулярной остео-томии был существенно снижен за счет исполь-зования методики безопасной хирургической дислокации Ганца, основанной на детальной оценке крово снабжения головки бедренной ко-сти [10,11]. Круговой анастомоз, образованный ветвями медиальной и латеральной артерий, огибающих бедренную кость у основания шей-ки бедренной кости, дает начало восходящим ретинакулярным артериям, которые пересекают шейку бедра, а затем образуют еще один непол-ный арте риальный анастомоз в субкапитальной области (кольцо Chung) [12,13].…”