Interlocking Triple Pelvic Osteotomy in Severe Legg-Calvé-Perthes Disease

Bache, C. E.; Kumar, Dileep; O’Hara, John N.

doi:10.1097/01241398-200207000-00010

Cited by 38 publications

(35 citation statements)

References 18 publications

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“…In doing so, surgeons aim to improve biomechanics of the hip and delay, or prevent, joint degeneration. Both acetabuloplasty [4] and acetabular reorientation procedures (Bernese [5], triple [21], Birmingham [11]) have been described as joint-preserving surgical options in patients with symptomatic, dysplastic hips. Among those, the Bernese periacetabular osteotomy (PAO), first described in 1988, has been the one most widely used.…”

Section: Introductionmentioning

confidence: 99%

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

Grammatopoulos

Wales

Kothari

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described. Questions/purposes The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction. Methods The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle\25°and nonhorizontal acetabular roof) in developmentally mature hips without evidence of major joint incongruence or subluxation. Most patients were female (n = 49 [60 hips, 88%]); mean age at operation was 25 years (SD 7). Sixteen hips had previous hip procedures. The study's mean followup was 8 years (range, 2-18 years). Patient-reported functional outcome was obtained using the WOMAC score (best-worst: 0-96). Radiographic parameters of dysplasia (acetabular index [AI], center-edge angle [CEA], congruency, Tönnis grade, and joint space) were evaluated from preoperative and postoperative radiographs using computer software. Results The 10-year survival rate was 93% (95% confidence interval [CI], 82%-100%); four patients underwent further surgery to the hip in the study period. The mean WOMAC was 12 (range, 0-54 Conclusions This study reports excellent results after Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it. Level of Evidence Level III, therapeutic study.

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Section: Introductionmentioning

confidence: 99%

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

Grammatopoulos

Wales

Kothari

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Despite including children who were younger than 7 years old [10,11,18,25,26] in five studies using four of the six PROs found (mHHS, HHS, Iowa, Merle d'Aubigné), the papers reviewed indicated no issues in the administration of these adult PROs (Table 2). Several papers directly compared results from a PRO administered to pediatric patients with results from adult studies using the same PRO [5,10,16,23,26].…”

Section: Discussionmentioning

confidence: 99%

What Clinimetric Evidence Exists for Using Hip-specific Patient-reported Outcome Measures in Pediatric Hip Impingement?

d’Entremont

Cooper

Johari³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

“…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].…”

mentioning

confidence: 99%

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

Hosalkar

Cunha

Baldwin

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calvé-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement. Questions/purposes We therefore asked (1) whether TIO contained the femoral head in Catterall Stages III and IV of LCPD; (2) whether the center-edge (CE) angle, acetabular roof arc angle (ARA), and Sharp's angle changed during the growing years; and (3) what percentage of patients had radiographic evidence of pincer impingement beyond a minimum followup of 3 years.

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Interlocking Triple Pelvic Osteotomy in Severe Legg-Calvé-Perthes Disease

Cited by 38 publications

References 18 publications

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

What Clinimetric Evidence Exists for Using Hip-specific Patient-reported Outcome Measures in Pediatric Hip Impingement?

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

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