Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy

Rosello, Olivier; Solla, Federico; Oborocianu, Ioana; Chau, E.; ElHayek, Tony; Clément, Jean-Luc; Rampal, Virginie

doi:10.5301/hipint.5000569

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…Conservative treatment possibilities are load restriction, physiotherapy and orthoses; however, these treatments are ineffective [4]. Possible surgical options after healed LCP include adductor tenotomy [12], osteochondroplasty [13], valgus-extension intertrochanteric osteotomy [13,14] and acetabular osteotomy [15,16], but these approaches do not correct of the actual bone deformity. In one-third of the patients, pain and stiffness reach unbearable levels due to early joint degeneration.…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted femoral head reduction osteotomies: an approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

Fürnstahl

Casari

Ackermann

et al. 2020

BMC Musculoskelet Disord

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Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe. Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test. Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively. Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

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Section: Introductionmentioning

confidence: 99%

Computer-assisted femoral head reduction osteotomies: an approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

Fürnstahl

Casari

Ackermann

et al. 2020

BMC Musculoskelet Disord

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“…The hip centering can be achieved either by centering the femoral head in the acetabulum via an intertrochanteric, femoral varization osteotomy ( Figure 2) or centering the acetabulum over the femoral head via a pelvic osteotomy (triple/Salter osteotomy) ( Figure 3). Due to many years of experience, good outcomes and results in the literature [26,27], we prefer the pelvic osteotomy of the femoral osteotomy, since there is no shortening of the leg and thus, no change in the lever arm of the abductors. Subsequently there is a lower risk of adduction contracture and a verticalization of the epiphysis, as it is the case with femoral varization osteotomy.…”

Section: Operative Treatmentmentioning

confidence: 99%

Legg-Calvé-Perthes Disease and Its Physiotherapy - “If the Hip Melts Away”

AH¹

2018

ORP

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ClassificationsThe disease progresses into 4 chronological stages ( Figure 1):• Condensation stage (Ø 7 months)• Fragmentation stage (Ø 8.5 months)• Reossification stage (Ø 18 months)• End stage [15] Krieg AH, et al., J Orthop Res Physiother 2018, 3: 037 Abstract Legg-Calvé-Perthes disease (or Perthes disease) is a disorder of the hip, which is caused by a vascular disorder ischemia of the femoral head and passes through four stages. It affects mostly infants and children of caucasian population. The cause of the ischemia is not yet known and therefore cannot be prevented norreversed. Limping, restriction of the movement and pain can lead to the diagnosis. X-rays as well as Magnetic Resonance Imaging (MRI) confirms it. The classification of Herring (A-C) is helpful to make a clinical prognosis and further treatment. The main aim of therapy is to improve joint the mobility and the joint's congruence ("containment"), build up muscle strength and reduce pain. Physiotherapy is an undisputed method, lasts over years involving an extensive movement therapy of the affected hip, the torso and the non-affected limb. Short-term drug-related analgesia, botulinum injection into the adductors and a weight relief can accompany therapy. An indication for operative treatment is given by subluxation within stadium B or B/C of Herring. Containment (hip centering/ joint's congruence) can be achieved by femoral varization osteotomy or pelvic osteotomy. Only one quarter of all patients is treated with surgery and physiotherapy remains the most relevant therapy on Perthes disease.

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“…Conservative treatment possibilities are load restriction, physiotherapy and orthoses; however, these treatments are ineffective (5). Possible surgical options after healed LCP include adductor tenotomy (13), osteochondroplasty (14), valgus-extension intertrochanteric osteotomy (14,15) and acetabular osteotomy (16,17), but these approaches do not correct of the actual bone deformity. In one-third of the patients, pain and stiffness reach unbearable levels due to early joint degeneration.…”

Section: Introductionmentioning

confidence: 99%

Computer-Assisted femoral head reduction osteotomies: An approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

Fürnstahl

Casari

Ackermann

et al. 2020

Preprint

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Background Legg–Calvé–Perthes (LCP) is a common orthopedic childhood disease that causes a deformity of the femoral head and to an adaptive deformity of the acetabulum. The altered joint biomechanics can result in early joint degeneration that requires total hip arthroplasty. In 2002, Ganz et al. introduced the femoral head reduction osteotomy (FHRO) as a direct joint-preserving treatment. The procedure remains one of the most challenging in hip surgery. Computer-based 3D preoperative planning and patient-specific navigation instruments have been successfully used to reduce technical complexity in other anatomies. The purpose of this study was to report the first results in the treatment of 6 patients to investigate whether our approach is feasible and safe.Methods In this retrospective pilot study, 6 LCP patients were treated with FHRO in multiple centers between May 2017 and June 2019. Based on patient-specific 3D-models of the hips, the surgeries were simulated in a step-wise fashion. Patient-specific instruments tailored for FHRO were designed, 3D-printed and used in the surgeries for navigating the osteotomies. The results were assessed radiographically [diameter index, sphericity index, Stulberg classification, extrusion index, LCE-, Tönnis-, CCD-angle and Shenton line] and the time and costs were recorded. Radiologic values were tested for normal distribution using the Shapiro–Wilk test and for significance using Wilcoxon signed-rank test.Results The sphericity index improved postoperatively by 20% (p = 0.028). The postoperative diameter of the femoral head differed by only 1.8% (p = 0.043) from the contralateral side and Stulberg grading improved from poor coxarthrosis outcome to good outcome (p = 0.026). All patients underwent acetabular reorientation by periacetabular osteotomy. The average time (in minutes) for preliminary analysis, computer simulation and patient-specific instrument design was 63 (±48), 156 (±64) and 105 (±68.5), respectively.Conclusion The clinical feasibility of our approach to FHRO has been demonstrated. The results showed significant improvement compared to the preoperative situation. All operations were performed by experienced surgeons; nevertheless, three complications occurred, showing that FHRO remains one of the most complex hip surgeries even with computer assistance. However, none of the complications were directly related to the simulation or the navigation technique.

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Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy

Abstract: In our series, TPO provided better radiologic and clinical outcomes compared to Chiari osteotomy, specially concerning the final Stulberg classification. We concluded that TPO should be preferred when indicated.

Cited by 14 publications

References 29 publications

Computer-assisted femoral head reduction osteotomies: an approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

Computer-assisted femoral head reduction osteotomies: an approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

Legg-Calvé-Perthes Disease and Its Physiotherapy - “If the Hip Melts Away”

Computer-Assisted femoral head reduction osteotomies: An approach for anatomic reconstruction of severely deformed Legg-Calvé-Perthes hips. A pilot study of six patients

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