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

Abstract

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

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

“…The impingement conflict occurs between the greater or lesser trochanter on the femoral side and the ischium or supraacetabular ilium on the pelvic side [42]. Extraarticular impingement is rarely reported but can occur with complex deformities of the proximal femur [1,18,38]. The deformities are often the sequelae of Legg-Calvé-Perthes disease (LCPD) or ''Perthes-like'' deformities such as sequelae of slipped capital femoral epiphysis (SCFE), postseptic arthritis, and trauma [1,2,23,37].…”

“…Extraarticular impingement is rarely reported but can occur with complex deformities of the proximal femur [1,18,38]. The deformities are often the sequelae of Legg-Calvé-Perthes disease (LCPD) or ''Perthes-like'' deformities such as sequelae of slipped capital femoral epiphysis (SCFE), postseptic arthritis, and trauma [1,2,23,37]. Typically, the deformities include a highriding greater trochanter, a short femoral neck, and an aspherical femoral head-neck junction [1,2,23,37].…”

“…The deformities are often the sequelae of Legg-Calvé-Perthes disease (LCPD) or ''Perthes-like'' deformities such as sequelae of slipped capital femoral epiphysis (SCFE), postseptic arthritis, and trauma [1,2,23,37]. Typically, the deformities include a highriding greater trochanter, a short femoral neck, and an aspherical femoral head-neck junction [1,2,23,37]. Complex deformities of the proximal femur can cause both intraand extraarticular FAI, which can lead to degenerative hip pain, restricted ROM, and impaired abductor function [1].…”

“…Typically, the deformities include a highriding greater trochanter, a short femoral neck, and an aspherical femoral head-neck junction [1,2,23,37]. Complex deformities of the proximal femur can cause both intraand extraarticular FAI, which can lead to degenerative hip pain, restricted ROM, and impaired abductor function [1].…”

ABJS Carl T. Brighton Workshop on Hip Preservation Surgery: Editorial Comment

“…An improved understanding will require modern three-dimensional techniques to analyze joint kinematics. Although one recent report of joint-preserving surgery in LCPD [1] describes improvement in pain and ROM, larger combined data collection to demonstrate successful outcome is needed. Even more controversial is the treatment of SCFE.…”