Advanced Containment Methods for Legg-Calvé-Perthes Disease

Abstract

Level IV.

Triple Innominate Osteotomy for Legg-Calvé-Perthes Disease in Children: Does the Lateral Coverage Change With Time?

“…Based on the radiographic criteria defined earlier, all patients had containment of the capital epiphysis in the immediate postoperative period and at last followup (femoral head extrusion index \ 20%, CE angle [ 25°, Sharp's angle \ 42°). Surgical containment utilizing proximal femoral varus osteotomy or the Salter's innominate osteotomy may provide adequate containment in mild to moderate LCPD but can be problematic in more severe cases [35]. Proximal femoral osteotomy has the disadvantage of shortening an already short limb and producing a limp while Salter's innominate osteotomy may not achieve adequate acetabular rotation to cover the femoral head in patients with extensive necrosis [21].…”

“…It is important to note that study did not include advanced containment methods [9]. We found advanced containment methods (TIO) can lead to satisfactory outcomes (radiographic Stulberg Class I, II, or III) in almost all Lateral Pillar B and some Lateral Pillar C patients [35].…”

“…Several studies have clarified brace treatment is not very effective, either due to brace design or poor patient compliance [16,37]. Surgical methods of containment include proximal femoral osteotomy, innominate osteotomy, shelf acetabuloplasty, combined femoral varus with innominate osteotomy, and TIO [5,13,33,35]. The intention of a TIO is to contain the femoral head and consequently allow the spherical acetabulum to serve as a mold for the growing biologically plastic femoral head in LCPD.…”

“…Treatment methods including Salter innominate osteotomy combined with a proximal femoral varus osteotomy [5,33] and triple innominate osteotomy (TIO) [13,35] have provided good results even in cases of more severe head involvement. TIO centers the femoral head within the acetabulum during the fragmentation and reossification phase, allowing the spherical acetabulum to serve as a mold to the biologically plastic femoral head during the healing (revascularization) phase.…”

“…TIO centers the femoral head within the acetabulum during the fragmentation and reossification phase, allowing the spherical acetabulum to serve as a mold to the biologically plastic femoral head during the healing (revascularization) phase. While TIO allows correction of acetabular orientation and femoral head containment [13,35], it may also inadvertently cause overcoverage, leading to a pincer morphology and subsequent symptomatic femoroacetabular impingement (FAI), which is a prearthritic condition [1,35].…”