The Treatment of Femoral Head Deformity and Coxa Magna by the Ganz Femoral Head Reduction Osteotomy

Paley, Dror

doi:10.1016/j.ocl.2011.04.006

Cited by 51 publications

(75 citation statements)

References 24 publications

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“…This is comparable to the improvement found in hips with idiopathic FAI with an increase of the mean pain subscore from preoperatively 4 to 5 at followup [21]. Paley [16] reported the clinical results of 20 patients (20 hips) after femoral head reduction osteotomy. Both surgical technique and hip disorders (LCPD and hip dysplasia) were comparable to the current study.…”

Section: Discussionsupporting

confidence: 67%

“…Both surgical technique and hip disorders (LCPD and hip dysplasia) were comparable to the current study. At a mean followup of 2.7 years (range, 1-5 years), he reported improvement in gait in all 20 hips, improvement in pain in 17 of 20 hips, and improvement of ROM in 15 of 20 hips [16]. However, no clinical scores or detailed information of ROM were reported for this study [16].…”

Section: Discussionmentioning

confidence: 79%

“…Surgical hip dislocation with development of an extended retinacular soft tissue flap gives safe access to the femoral head and enables intracapital osteotomies. However, only limited information of clinical and radiographic outcome after femoral head reduction osteotomy has been reported [3,11,16]. We therefore asked whether femoral head reduction osteotomy in hips with severe asphericity of the femoral head results in (1) improved head sphericity and containment; (2) pain Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…The hip with Class IV according to Stulberg et al [23] and no improvement of head sphericity occurred in a 7-year-old boy, who required a subsequent triple osteotomy 10 months after index surgery to improve containment of the head (Table 4). Paley [16] reported a series of 20 patients (20 hips) undergoing femoral head reduction osteotomy and assessed femoral head sphericity using a ratio of femoral head diameter of the affected side divided by the diameter of the contralateral side [16]. An improvement in head sphericity from a mean ratio of 133% (range, 115%-160%) preoperatively to 96% (range, 91%-100%) postoperatively was reported [16].…”

Section: Discussionmentioning

confidence: 99%

“…Paley [16] reported a series of 20 patients (20 hips) undergoing femoral head reduction osteotomy and assessed femoral head sphericity using a ratio of femoral head diameter of the affected side divided by the diameter of the contralateral side [16]. An improvement in head sphericity from a mean ratio of 133% (range, 115%-160%) preoperatively to 96% (range, 91%-100%) postoperatively was reported [16]. No improvement of the total Merle d'Aubigné score or ROM was found at most recent followup (Table 3).…”

Section: Discussionmentioning

confidence: 99%

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

Siebenrock

Anwander

Zurmühle

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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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;

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 79%