Innominate osteotomy for the treatment of Legg-Calvė-Perthes disease

Park, Byeong Mun; Kim, Hyun Woo; Park, Soo Young

doi:10.3349/ymj.1996.37.3.200

Cited by 6 publications

(5 citation statements)

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“…Furthermore, many studies have evaluated surgical treatments for late-onset LCPD. Good outcomes were achieved in 50% to 62.5% of patients undergoing FVO [2, 13, 25], 8.3% to 50% of patients undergoing Salter innominate osteotomy [6, 22, 23], 26.7% to 52% of patients undergoing triple innominate osteotomy [26, 31, 32], 70% of patients undergoing Chiari osteotomy [18], 27.8% of patients undergoing shelf acetabuloplasty [21], and 30% of patients with combined FVO and Salter innominate osteotomy [10].…”

Section: Discussionmentioning

confidence: 99%

Does Flexion Varus Osteotomy Improve Radiographic Findings Compared With Patients Treated in a Brace for Late-onset Legg-Calvé-Perthes Disease?

Nakamura

Wada²,

Yamaguchi

et al. 2022

Clin Orthop Relat Res

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BackgroundLegg-Calvé-Perthes disease (LCPD) is a childhood hip disease characterized by osteonecrosis of the femoral head. Because severe deformity of the femoral head can cause secondary osteoarthritis in adulthood, progressive collapse should be prevented in children with a necrotic epiphysis. The prognosis of patients with LCPD generally worsens as the age at disease onset increases, and the appropriate treatment for late-onset LCPD remains unclear. Based on the limited effect of nonoperative treatment using a nonweightbearing brace, flexion varus osteotomy (FVO) was introduced in 2010 as an initial treatment for late-onset LCPD in place of brace treatment, which we used in our institution before that time.Questions/purposesWe asked, (1) Which treatment, FVO or a nonweightbearing brace, is associated with a lower likelihood of progressive femoral head collapse in children whose diagnosis of LCPD was made at the age of ≥ 8 years and who were followed for a minimum of 3 years after their intervention? (2) What proportion of patients in the brace group had surgery despite the treatment, and what percentage of children in the FVO group had a second operation to remove hardware and/or additional operations?MethodsThe initial treatment was applied in 181 patients with LCPD between 1995 and 2018 in our institution. Patients whose disease onset was at ≥ 8 years old (late-onset LCPD) with complete clinical and radiologic data were considered potentially eligible. In 2010, treatment for these patients changed from brace treatment to FVO for all patients. A total of 35% (42 of 121) of patients who were treated with a nonweightbearing brace between 1995 and 2009 and 40% (24 of 60) of patients who were treated with FVO between 2010 and 2018 were eligible. Among patients treated with a brace, 21% (nine of 42 patients) were excluded because of hospital transfer (three patients), short-term follow-up (three), the period from onset to the first visit was ≥ 7 months (two), and inability to use the brace because of mental incapacity (one patient). In patients treated with FVO, 12% (three of 24 patients) were excluded (two patients with a period from onset to the first visit ≥ 7 months and one with a comorbidity and multiple-epiphyseal dysplasia). Among the remaining patients, 79% (33 of 42 patients) were classified into the brace group and 88% (21 of 24 patients) were classified into the FVO group for analyses. There were no overlapping patients at the timepoint when the treatment strategy for late-onset LCPD changed. In the FVO group, subtrochanteric osteotomy with 35° to 40° of flexion and 15° to 20° of varus was performed using a locking compression plate for pediatric use. Patient demographics, radiographic parameters, and the assessment of femoral head deformity using the Stulberg classification were compared between the two groups. There was a greater proportion of boys than girls in both groups (brace: 88% and FVO: 86%), and there were no differences in the distribution of genders between the groups (p = 0.82). The...

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Section: Discussionmentioning

confidence: 99%

Does Flexion Varus Osteotomy Improve Radiographic Findings Compared With Patients Treated in a Brace for Late-onset Legg-Calvé-Perthes Disease?

Nakamura

Wada²,

Yamaguchi

et al. 2022

Clin Orthop Relat Res

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“…Innominate osteotomy can alter the natural process of LCPD and benefit femoral head remodeling during remaining growth. [3] Park et al and Yavuz et al [16,17] also indicated that Salter osteotomy could improve the sphericity of the femoral head. Salter osteotomy is an effective method of surgical treatment for LCPD in patients younger than 8 years.…”

Section: Discussionmentioning

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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“…Kim et al 11) reported his experiences of 13 FVO and their result with mid-term follow up were 31% good, 61% fair and 8% poor. Park and Choi 19) reported mid-term follow-up results in 23 FVO. Their results were 44% good hips, 52% fair hips and 4% poor hips.…”

Section: DI Is Sc Cu Us Ss Si Io On Nmentioning

confidence: 99%

“…Their results worsened with the increasing age of the patients at operation. We could find several papers reporting the mid-term or long term results of FVO in Korean LCPD children 11,19) . Kim et al 11) reported his experiences of 13 FVO and their result with mid-term follow up were 31% good, 61% fair and 8% poor.…”

Section: DI Is Sc Cu Us Ss Si Io On Nmentioning

confidence: 99%

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The Long Term Results of Femoral Varus Osteotomy in Patients with Legg-Calve-Perthes Disease

Wie¹,

Rowe²,

Jung³

et al. 2009

J Korean Hip Soc

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Purpose: The purpose of this study was to evaluate the long term results of performing femoral varus osteotomy (FVO) for the treatment of Legg-Calve-Perthes disease (LCPD). Materials and Methods:We selected 35 LCPD patients who received FVO and they were followed up to the time their skeletons' matured. The inclusion criteria were patients in a fragmentation stage, the patients were in Catterall group Ⅲ or Ⅳ, and the patients underwent a teleoroentgenographic examination at the time of full skeletal maturity. Results:The radiological outcome at the time of skeletal maturity was assessed using Stulberg's classification. The final results were 4 hips in class I, 17 hips in class II, 13 hips in class III, one hip in class IV and none in class V. The satisfactory results (good+fair hips) were 34 hips (97%). Significant shortening (>10 mm) was observed in 12 hips (34%). In 35 patients, 5 (14%) had same leg length (less than 2 mm difference), 27 (77%) had shortening of 2 mm or more, and 3 had lengthening of 2 mm or more in the operated limb. Of these 12 patients with significant shortening, only 3 patients (9%) showed shortening of 21 mm or more. Conclusion:FVO is a reliable method for managing LCPD in patients who are in Catterall group III or IV and who are in the fragmentation stage of disease.

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Innominate osteotomy for the treatment of Legg-Calvė-Perthes disease

Cited by 6 publications

References 0 publications

Does Flexion Varus Osteotomy Improve Radiographic Findings Compared With Patients Treated in a Brace for Late-onset Legg-Calvé-Perthes Disease?

Does Flexion Varus Osteotomy Improve Radiographic Findings Compared With Patients Treated in a Brace for Late-onset Legg-Calvé-Perthes Disease?

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

The Long Term Results of Femoral Varus Osteotomy in Patients with Legg-Calve-Perthes Disease

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