Intertrochanteric osteotomy in young adults for sequelae of Legg-Calv�-Perthes? disease?a long term follow-up

Pécasse, Guy A B M; Eijer, Henk; Haverkamp, Daniël; Marti, René K

doi:10.1007/s00264-003-0513-2

Cited by 14 publications

(8 citation statements)

References 24 publications

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“…The mean Harris hip score of 83 and WOMAC score of 6 at most recent followup (Table 2) were comparable to the reported results in the literature for hips with complex femoral deformities and relative femoral neck lengthening (mean Harris hip score of 87 [2] and WOMAC score 3.5 [35]). In contrast, hips with LCPD after isolated intertrochanteric osteotomy without correction of intraarticular impingement or advancement of the greater trochanter showed a lower mean Harris hip score of 78.5 [31]. Abductor strength in hips with a proximal femoral deformity is often impaired as a result of the shortened femoral neck, high-riding greater trochanter, and varus hip morphology, which result in a decreased lever arm for the abductor muscles [32].…”

Section: Discussionmentioning

confidence: 86%

Relative Femoral Neck Lengthening Improves Pain and Hip Function in Proximal Femoral Deformities With a High-riding Trochanter

Albers

Steppacher

Schwab

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Complex proximal femoral deformities, including an elevated greater trochanter, short femoral neck, and aspherical head-neck junction, often result in pain and impaired hip function resulting from intra-/ extraarticular impingement. Relative femoral neck lengthening may address these deformities, but mid-term results of this approach have not been widely reported. Questions/purposes Do patients who have undergone relative femoral neck lengthening show (1) less hip pain and greater function; (2) improved radiographic parameters; (3) significant complications requiring subsequent surgery; and (4) progression of osteoarthrosis (OA) or conversion to total hip arthroplasty (THA) at mid-term followup? Methods We retrospectively reviewed 40 patients (41 hips) with isolated relative femoral neck lengthening between 1998 and 2006 with sequelae of Legg-Calvé-Perthes disease (38 hips [93%]), slipped capital femoral epiphysis (two hips [5%]), and postseptic arthritis (one hip [2%]). During this time, the general indications for this procedure included a high-riding greater trochanter with a short femoral neck with abductor weakness and symptomatic intra-/extraarticular impingement. Mean patient followup was 8 years (range, 5-13 years), and complete followup was available in 38 patients (39 hips [95%]). We evaluated pain and function with the impingement test, limp, abductor force, Merle d'Aubigné-Postel score, and range of motion. Radiographic parameters included trochanteric height, alpha angle, and progression of OA. Subsequent surgeries, complications, and conversion to THA were summarized. Results The proportion of positive anterior impingement tests decreased from 93% (38 of 41 hips) preoperatively to 49% (17 of 35 hips) at latest followup (p = 0.002); the proportion of limp decreased from 76% (31 of 41 hips) to 9% (three of 35 hips; p \ 0.001); the proportion of normal abductor strength increased from 17% (seven of 41 hips) to 91% (32 of 35 hips; p \ 0.001); mean Merle d'Aubigné-Postel score increased from 14 ± 1.7 (range, 9-17) to 17 ± 1.5 (range, 13-18; p \ 0.001); mean internal rotation increased to 25°± 15°(range, 0°-60°; p = 0.045), external rotation to 32°± 14°(range, 5°-70°; p = 0.013), and abduction to 37°± 13°(range, 10°-50°; p = 0.004). Eighty percent of hips (33 of 41 hips) showed normal trochanteric height; alpha angle improved to 42°± 10°(range, 27°-90°). Two hips (5%) had subsequent surgeries as a result of lack of containment; four of 41 hips (10%) had complications resulting in reoperation. Fourteen of 35 hips (40%) showed progression of OA; four of 40 hips (10%) converted to THA. Conclusions Relative femoral neck lengthening in hips with combined intra-and extraarticular impingement results in reduced pain, improved function, and improved radiographic

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Section: Discussionmentioning

confidence: 86%

Relative Femoral Neck Lengthening Improves Pain and Hip Function in Proximal Femoral Deformities With a High-riding Trochanter

Albers

Steppacher

Schwab

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…In addition, all amplitudes of hip ROM except flexion improved after surgery (Table 3). Although a similar effect on ROM has been described in some articles [3,7], this is not the case with other surgical techniques for treatment of the sequelae of LCPD in the literature [27,32] (Table 5). There are two main reasons why hip flexion did not change after surgery.…”

Section: Discussionmentioning

confidence: 88%

Joint-preserving Surgery Improves Pain, Range of Motion, and Abductor Strength After Legg-Calvé-Perthes Disease

Albers

Steppacher

Ganz

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Patients after Legg-Calvé-Perthes disease (LCPD) often develop pain, impaired ROM, abductor weakness, and progression of osteoarthritis (OA) in early adulthood. Based on intraoperative observations during surgical hip dislocation, we established an algorithm for more detailed characterization of the underlying pathomorphologies with a proposed joint-preserving surgical treatment. Questions/purposes We asked if patients after LCPD treated with our algorithm experienced (1) reduced pain; (2) improved hip function; and/or (3) prevention of OA progression; we then determined (4) the intraoperative damage patterns; (5) the survival of the hip; and (6) factors predicting the need for a conversion to THA; radiographic progression of OA; a Merle d'Aubigné-Postel score below 15 at last followup; and/or the need for revision surgery. Methods We retrospectively reviewed 53 patients after LCPD who underwent joint-preserving surgery (40 surgical hip dislocations, eight acetabular osteotomies, four combined procedures, and one intertrochanteric osteotomy). We obtained Merle d'Aubigné-Postel scores to assess pain; OA was assessed using Tönnis grades. Survival and predictive factors were calculated with the univariate Cox regression. Fifty of the 53 patients were evaluated at a minimum of 5.1 years (mean, 8.2 years; range, 5

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“…Pécasse et al [15] report improvement in clinical function, pain reduction, and delay in progression of joint degeneration in young adults operated for sequelae of LCP disease.…”

Section: Discussionmentioning

confidence: 98%

Legg–Calvé–Perthes disease affecting children less than eight years of age: a paired outcome study

Sharma

Shewale²,

Sibiński³

et al. 2008

International Orthopaedics (SICO

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Intertrochanteric osteotomy in young adults for sequelae of Legg-Calv�-Perthes? disease?a long term follow-up

Cited by 14 publications

References 24 publications

Relative Femoral Neck Lengthening Improves Pain and Hip Function in Proximal Femoral Deformities With a High-riding Trochanter

Relative Femoral Neck Lengthening Improves Pain and Hip Function in Proximal Femoral Deformities With a High-riding Trochanter

Joint-preserving Surgery Improves Pain, Range of Motion, and Abductor Strength After Legg-Calvé-Perthes Disease

Legg–Calvé–Perthes disease affecting children less than eight years of age: a paired outcome study

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