Chiari Pelvic Osteotomy in Perthes Disease

Jp, Cahuzac; Onimus, M; Trottmann, F.; Jl, Clément; Jm, Laurain; Lebarbier, P

doi:10.1097/01241398-199003000-00004

Cited by 28 publications

(4 citation statements)

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“…TPO is interesting in this indication as, compared with Chiari osteotomies, the socket cover is cartilaginous rather than fibrous. A successful containment with subsequent remodeling and improvement of Wiberg angle and acetabular index has been reported after this procedure, even in severe cases (22-26). The postoperative stability of the osteotomy allows early and progressive weight-bearing, as soon as pain is controlled.…”

Section: Discussionmentioning

confidence: 87%

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

et al. 2017

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Section: Discussionmentioning

confidence: 87%

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

et al. 2017

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“…[113][114][115][116][117] A similar concept of creating a cover for the extruded part of the femoral epiphysis is the rationale behind performing a Chiari osteotomy. [118][119][120][121][122][123][124] Combined femoral and innominate osteotomies. Combined femoral and innominate osteotomies have been practiced by a few surgeons.…”

Section: Innominate Osteotomy In Many Centers In Northmentioning

confidence: 99%

“… 113 – 117 A similar concept of creating a cover for the extruded part of the femoral epiphysis is the rationale behind performing a Chiari osteotomy. 118 – 124 …”

Section: Managementmentioning

confidence: 99%

Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes

Joseph,

Shah,

Perry

2023

Journal of Children's Orthopaedics

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Background: Legg–Calvé–Perthes disease is a self-limiting disorder that develops in children following interruption of the blood supply to the capital femoral epiphysis. This review outlines the current knowledge on the epidemiology, natural evolution, clinical spectrum, and management of the disease. Methods: The literature pertaining to these aspects of the disease were studied and summarized in this review. Results: Epidemiological studies suggest that environmental factors contribute to the causation of the disease. Incidence rates monitored over time indicate that the incidence of Legg–Calvé–Perthes disease is declining. The natural evolution followed on sequential plain radiographs enables division of the disease into Stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV. Reversible deformation of the capital occurs in Stages Ia–IIa simply on standing while irreversible deformation may occur in Stages IIb and IIIa. Treatment of Legg–Calvé–Perthes disease in Stages Ia–IIa aims to prevent the femoral head from getting deformed by containment and avoidance of weight-bearing. In Stages IIb and IIIa, treatment aims to remedy the effects of early irreversible deformation of the femoral head. In Stage IIIb and IV, treatment is directed to correcting the altered shape of the femoral head. The impression that these treatment methods are helpful is based on poor quality evidence. Conclusion: There is an urgent need to undertake Level I studies to establish the efficacy of currently treatment. Level of evidence: level V.

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“…Apart from the age at diagnosis and surgery, the severity of femoral head flattening and the signs of “head at risk” are also associated with the final clinical outcome. [1] The current surgical treatment options, including proximal femoral varus osteotomy, [2] innominate osteotomy, [3] lateral shelf acetabuloplasty, [4] triple pelvic osteotomy, [5] and Chiari pelvic osteotomy, [6] have proved to be effective in covering the femoral head within the acetabulum. To promote the coverage of the femoral head, shelf acetabuloplasty directly increases the size of the acetabulum by implanting graft bone to the lateral rim.…”

Section: Introductionmentioning

confidence: 99%

Lateral shelf acetabuloplasty for severe Legg–Calvé–Perthes disease in patients older than 8 years

Ren

2016

Medicine

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The natural history of Legg–Calvé–Perthes disease (LCPD) in children older than 8 years is usually poor without treatment. The treatment goal is to prevent deformity and incongruity of the hip by achieving a stable spherical femoral head in a deep, congruent, sharp-edged acetabulum, with a good range of hip movement at skeletal maturity. Lateral shelf acetabuloplasty in LCPD can increase the coverage of the femoral head, benefiting the remodeling of the femoral head and acetabulum. The aim of this study was to evaluate the efficacy of lateral shelf acetabuloplasty for severe LCPD in patients older than 8 years.We evaluated 51 patients with severe LCPD who underwent shelf acetabuloplasty between 1994 and 2005. Clinical and radiological examinations were evaluated preoperatively and over a mean follow-up of 132.35 months (range 102–183 months). According to the Catterall classification, the LCPD was classified as grade II in 11 (21.6%) patients, grade III in 15 (29.4%), and grade IV in 25 (49.0%). According to the Herring classification, there were 12 (23.5%) patients in grade B, 24 (47.1%) in grade B/C, and 15 (29.4%) in grade C. The mean ages at the onset of signs and at surgery were 103.39 months and 110.78 months, respectively.By the end of follow-up, all patients had a normal passive range of hip movement without pain. The mean Iowa hip score was improved from 69.5 ± 7.28 to 91.6 ± 5.14 (P < 0.001). According to the Stulberg classification, 11 (21.6%) hips were classified as grade 1, 19 (37.3%) hips as grade 2, 14 (27.5%) hips as grade 3, and 7 (13.7%) hips as grade 4. The CE angle, Sharp angle, medial joint space ratio, epiphysis height ratio, and percentage of acetabular coverage were significantly improved by shelf acetabuloplasty (P < 0.001).We recommend shelf acetabuloplasty for severe LCPD in patients older than 8 years. The procedure yields a favorable clinical outcome and Stulberg outcome for the hip. Shelf acetabuloplasty can improve femoral head coverage and reduce subluxation of the hip, with a benefit to the biological remodeling of the femoral head within the acetabulum.

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Chiari Pelvic Osteotomy in Perthes Disease

Cited by 28 publications

References 0 publications

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

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

Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes

Lateral shelf acetabuloplasty for severe Legg–Calvé–Perthes disease in patients older than 8 years

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