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

Abstract

BackgroundStandard 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.MethodsWe 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.ResultsThe 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.ConclusionsThe 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.

Mid–Long-Term Outcomes of Surgical Treatment of Legg-Calvè-Perthes Disease: A Systematic Review

“…Four articles looked at FVO [ 17 , 18 , 19 , 22 ], two articles evaluated the combination of FVO + Salter osteotomy [ 23 , 26 ], eight articles examined lateral shelf acetabuloplasty [ 20 , 24 , 27 , 28 , 29 , 33 , 36 , 37 ], two articles addressed arthrodiastasis [ 25 , 30 ], tow articles analyzed the Salter osteotomy [ 34 , 39 ], and two articles described the rotational transtrochanteric osteotomy [ 31 , 32 ]. Finally, one article analyzed the Chiari osteotomy [ 21 ], one the triple osteotomy [ 38 ], and one the combination of shelf acetabuloplasty + FVO [ 35 ].…”

Long-term follow up of varus osteotomy of the femur in patients with Perthes` disease in Erbil City

“…24 another study in Korea showed different results, out of 12 patients revealed Stulberg gradeI, 0 cases; Stulberg grade II, 4 cases (34%); Stulberg III, 7cases (58%); Stulberg IV, 1 case (8%); and Stulberg V, 0 cases. 10 Our study showed that more than half of the cases had a central edge angle of 26º-40º followed by those having ≤ 25º and those with > 40º (31.8% & 9.1%, respectively). This is inconsistent with results of a study in Korea, where the mean angular correction of the varus osteotomy in group A was 20° and the mean medial displacement was 21%, the angular correction of valgus osteotomy in group B was 28°, and lateral displacement was 41%.…”

Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review

“…The characteristics of the included studies [1,9,10,32,[44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] are reported in Multimedia Appendix 1.…”