Impingement-free hip range of motion after osteochondroplasty and relative neck lengthening in adults with healed Perthes disease

Abstract

Objective: Our main objective is to assess the efficiency of the osteochondroplasty with relative neck lengthening in adults with healed Perthes clinically (through assessment of impingement-free hip ROM, functional scores) and radiographically. Patients and methods: This was a prospective case series study included 30 hips of 30 patients who underwent osteochondroplasty and RNL due to symptomatic healed LCPD. This study included 16 males (53.3%) and 14 females (46.7%). The age of patients ranged from 19 to 40 years with mean age 26.4 years at the date of surgery (SD 6.4). Results: Median time of follow-up was 27.7 months after surgery (range 12-60 months). Two patients (6.6%) developed avascular necrosis (AVN) and needing total hip replacement; none of our patients developed nerve injury, detachment of the trochanteric fragment, and wound infection needing treatment. Preoperative Stulberg classes II and III improved more than preoperative Stulberg classes IV and V, although not statistically significant (P = 0.1104, n = 30). The mean HHS and WOMAC score values for each patient were higher in the Stulberg II and III groups compared to the Stulberg IV and V groups Conclusion: Head and neck osteochondroplasty performed through the surgical dislocation approach, combined with RFNL, relieved pain and restored function in most of the patients with reasonable complications.

Treatment of Symptomatic Residual Deformity in Legg-Calvé-Perthes Disease

“…Although surgical failure was defined only as conversion to THA (4 hips, 15%), clinical failure was reported for 5 (18.5%) on the basis of a modified Harris hip score of <70 points, resulting in a combined failure of 33% in that study. In our study, only 2 (15%) of the patients had undergone a THA at the time of follow-up, similar to the rates of conversion to THA of between 7% to 15% found in previous studies 10,13,14,[28][29][30] .…”

“…Our findings showed that, at a median of 10 years after surgery, patients with symptomatic residual LCPD deformity with preserved hips experienced a significant improvement in the WOMAC pain and stiffness scores but not in the WOMAC score for function in daily activities. The lack of improvement in WOMAC function was unexpected, as most previous studies have reported increased function in activities of daily living after SHD for LCPD 9,10,14,[27][28][29] . A previous study pointed out that one of the limitations of the WOMAC is that a patient's WOMAC score does not necessarily align with the patient's perception of their level of dysfunction 14 .…”

“…Depending on the specific abnormalities, the surgeon can use various concomitant procedures to improve the femoral morphology and the hip mechanics 12 . Although several studies reported short-term improvement in pain and function using SHD, there are limited data on the intermediate and long-term clinical outcomes, survival rate, and factors predictive of failure to preserve the hip following SHD 9,10,13,14,16,[27][28][29] .…”

Intraarticular hip preservation procedures in healed Perthes disease: a systemic review and meta-analysis

“…To the best of the authors’ knowledge, no comparative studies directly compared the clinical outcomes of RFNL versus FHRO. However, their results were in line with recent reports showing a significant improvement in hip function, ROM, and postoperative pain following RFNL and FHRO 17,27. The authors recommend interpreting those results cautiously because the follow-up duration within the studies was limited.…”

“…However, their results were in line with recent reports showing a significant improvement in hip function, ROM, and postoperative pain following RFNL and FHRO. 17,27 The authors recommend interpreting those results cautiously because the follow-up duration within the studies was limited. A sufficiently long follow-up is crucial to ensure the continuity of the excellent early results and determine whether these procedures will alter the natural history of the disease.…”