The Long-Term Outcome After Varus Derotational Osteotomy for Legg-Calvé-Perthes Disease

Shohat, Noam; Copeliovitch, Leonel; Smorgick, Yossi; Atzmon, Ran; Mirovsky, Yigal; Shabshin, Nogah; Beer, Yiftah; Agar, Gabriel

doi:10.2106/jbjs.15.01349

Cited by 29 publications

(16 citation statements)

References 28 publications

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“…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.…”

Section: Overviewmentioning

confidence: 99%

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

Maleki¹,

Qoreishy²,

Bahrami³

2021

Interact J Med Res

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Background Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

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“…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.…”

Section: Overviewmentioning

confidence: 99%

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

Maleki¹,

Qoreishy²,

Bahrami³

2021

Interact J Med Res

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“…The D and s are an average of respective values in both the view. Caput index (CI) is calculated = ([s × 2]/D) [24] . Caput index is used to measure the sphericity of femoral head Caput index > 70% is considered as good, CI =50-70% is fair and CI<50 is poor.…”

Section: Radiological Parametersmentioning

confidence: 99%

“…The epiphyseal quotients (EQ) are calculated from the X-rays (the EQ is the ratio of the epiphyseal index of the involved head with that of the uninvolved head. The epiphyseal index is calculated by the greatest height of the epiphysis divided by its width [24] . The EQ was graded as good (>60%), fair (40%-60%) and poor (≤40%) [16] .…”

Section: Radiological Parametersmentioning

confidence: 99%

“…We classified the results of treatment of hips along the following criteria [17,24] . Good -radiologically: Spherical head fully contained by the acetabulum: (EQ over 60%, Clinically No symptoms, full range of hip movements), Fair -radio logically: Caput congruent, more than 4/5 of the head covered (EQ within 40%-60%, Clinically: No symptoms, slight restriction of hip movements); Poor -radiologically: Caput irregular, more than 1/5 of the head uncovered (EQ <40%, Clinically Symptoms present, marked restriction of hip movements).…”

Section: Radiological Parametersmentioning

confidence: 99%

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Role of containment in late onset and early healed perthes-functional outcome

Ashraf¹,

Salam²,

Ahammad³

2020

Int. J. Orthop. Sci.

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Role of surgical containment in late onset and healed Perthes is still controversial and ill defined. Untreated and partially treated Perthes disease can progress to osteoarthritis by the fourth decade. The main complication is femoral head deformation. Two important factors contributing to complication: 1. Extruded femoral head 2. Deformed head leads to early onset of osteoarthritis This study evaluates the clinical and radiological outcome of varus derotation osteotomy (VDRO) in late onset and early healed Perthes with extruded femoral head with remaining growth potential. Materials and Methods: 30 children (19 males and 11 females) falling in the group of 10-16 years, belonging to modified Elizabethtown classification Stage 4-healed stage / Waldenstrom's stage 4residual stage, radiologically -reossified, extruded, deformed femoral head are treated with open wedge VDRO, between 2009 and 2017 were included in this study. 21(70%) are between 10-14yrs, rest are 14 -16yrs, mean age of osteotomy is 12.37yrs. All patients had limitation of abduction and internal rotation. 14 patients (46.67%) had pain at the hip and 26 patients (86.7%) had limp. Mean time between diagnosis and corrective surgery was 3 weeks. Results: The evaluation was done using caput index (CI) and epiphyseal quotient (EQ) radiologically, range of motion and Harris Hip Score for clinical outcome.Our minimum follow up was 3yrs and maximum follow up of 10years. We studied Radiological and clinical parameters on 3 rd year follow up. All measurement was done on pre-op, post op x-rays at 3 rd year follow up and also compared with the contralateral hip. We noted improvement in the clinical outcome and radiologically femoral head attained more spherical contour after containment. In our studies 21 children (70%) had good result with Spherical head and fully contained by acetabulum, 6 children (21%) had fair result with congruent head and acetabulum covering>4/5 th of femoral head. Rest 3 children had poor result with clinically symptomatic and extruded deformed head. There was a significant change (P = 0.000) in CI among all the patients after surgery. The final EQ after 3 years of VDRO was 0.685 and was significant (P = 0.0000). Conclusion:In Healed perthes with extruded and deformed femoral head, containing with VDRO helps to achieve a spherical femoral head, thereby delaying the onset of osteoarthritis. Mould for a spherical femoral head is the acetabulum. Containg the head resumes its growth until achieving skeletal maturity. The remaining growth potential is utilized to mould the head into sphericity.

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“…[20] Kırk hastanın 43 kalçasına uygulanan femoral varus osteotomisinin 33 yıllık takibinin sonuçlarını inceleyen bir çalışma-da [21] , proksimal femoral varus osteotomisinin uzun dönem sonuçlarının iyi olduğu ve Stulberg sınıflama-sının hastanın fonksiyonel sonuçlarını yansıtmada iyi bir ölçüt olduğu belirtilmiştir. Yine, ortalama 42 yıllık sonuçları inceleyen başka bir çalışmada [22] da femoral varus osteotomisi yapılan hastaların çoğunluğunda klinik ve radyografik sonuçların iyi olduğu vurgulanmıştır. Tercier ve arkadaşları, 2012 yılında femoral varus osteotomisi yaptıkları 101 hastada, varus osteotomisi sonrası alt ekstremitede valgus dizilimi gelişip gelişmediği hipotezini incelemişler, varus osteotomisi…”

Section: Kaynaklarunclassified

LCP hastalığının tedavisinde varus osteotomisinin yeri ve etkinliği; güncel değerlendirme

Marangoz¹

2017

TOTBID

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sınırlılıkları tanımlanmış bir yöntem haline gelmiştir. 1980 yılında Axer ve arkadaşları, femoral osteotominin sonuçlarını incelemiştir. [2] Esas olarak, femur başının dışa taşan kısmının asetabulum tarafından daha fazla zarar görmesinin engellenmeye çalışılması vurgulanmış ve kimlerin en çok yarar görebileceğine dair çıkarımlar yapılmıştır. Sonuçlar genel olarak yüzde 83 oranında tatmin edici iken, hastaların yüzde 17'sinde teknik başarısız olmuştur. 2004 yılında yayımlanan, uzun dönem sonuçları yansıtan çok merkezli ileriye dönük bir çalışmada [3] femoral varus osteotomisi veya Salter iliak (innominate) osteotomisi yapılan spesifik bir hasta grubunda, sonuçların daha iyi olduğu belirtilmiş-tir. Wiig ve arkadaşları [4] tarafından Norveç'te yürü-tülen çok merkezli bir çalışmada, altı yaşından büyük %50'den fazla femur başı nekrozu olan hastada, fizik tedavi, abduksiyon ortezi ve proksimal femoral varus osteotomisi karşılaştırılmıştır. Varılan sonuç, femoral osteotominin anlamlı olarak daha iyi sonuç verdiğidir. Altı yaşının altında yapılan tedaviler arasında bir fark bulunamamıştır. Dolayısıyla, bu yazarlar abduksiyon L egg-Calvé-Perthes hastalığı ya da sık kullanan şekliyle Perthes hastalığı, 100 yılı aşkın bir süre-dir gizemini koruyan, çocukluk çağının sık görü-len kalça rahatsızlıklarından birisidir. Etiyolojisi üze-rine yapılan çalışmalar süregelmekte olup tedavisi ile ilgili üzerinde fikir birliğine varılamamış birçok husus vardır. Femur başını ilgilendiren bu hastalıkta, femur başında meydana gelen değişiklikler neticesinde femoroasetabular eklem uyumunun bozulmaması için önerilen tedavi yöntemleri vardır. Bunların hepsinin de temel aldığı nokta, kapsama (containment) felsefesidir. Eklem hareket genişliğinin korunması ve femur başının asetabulum tarafından kapsanması sayesinde, yeniden şekillenme süreci ile femur başının yuvarlaklığının ya da en azından asetabulum ile uyumunun korunması amaçlanır. Varus osteotomisi, yüz yıldan fazla bir süredir gizemi çözü-lemeyen Perthes hastalığının tedavisinde kapsama felsefesini yerine getiren ve sıklıkla kullanılan cerrahi yöntemlerden birisidir. Lateral pillar sınıflamasına göre, B grubu ve B/C grubu en fazla yarar gören grubu oluşturur. Varus osteotomisi sonrası uzun süren veya kalıcı aksama ve kısalık görü-lebilmesi dezavantajıdır. Bu derlemede, bu konuda yazılmış belli başlı makaleler ve sonuçları bir araya getirilmiş ve okuyucuya Perthes hastalığında yapılacak varus osteotomisi açısından bir perspektif kazandırılması amaçlanmıştır. İlk olarak Axer

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The Long-Term Outcome After Varus Derotational Osteotomy for Legg-Calvé-Perthes Disease

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 29 publications

References 28 publications

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

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

Role of containment in late onset and early healed perthes-functional outcome

LCP hastalığının tedavisinde varus osteotomisinin yeri ve etkinliği; güncel değerlendirme

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