Outcome After Combined Pelvic and Femoral Osteotomies in Patients with Legg-Calvé-Perthes Disease

Mosow, N.; Vettorazzi, Eik; Breyer, Sandra; Ridderbusch, Karsten; Stücker, Ralf; Rupprecht, Martin

doi:10.2106/jbjs.16.00255

Cited by 23 publications

(22 citation statements)

References 27 publications

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“…A more robust way of demonstrating that the course of LCPD is not appreciably altered by concomitant JIA is a comparison with the previous study of Rupprecht et al [39]. serving as another control group.…”

Section: Discussionmentioning

confidence: 98%

Does Juvenile Idiopathic Arthritis Affect the Course of Legg–Calvé–Perthes Disease? A Case-Control Study with a Mean Follow-Up of 8 Years

Ross

Foeldvari²,

Krajewski

et al. 2021

Children

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Background: This study aimed to determine the clinical and radiological course in children who had Legg–Calvé–Perthes disease (LCPD) associated with juvenile idiopathic arthritis (JIA). Methods: In a retrospective chart review between 2007 and 2019, eight consecutive JIA patients diagnosed with concomitant LCPD were identified and compared with a case-control group of 10 children with LCPD only. Results: LCPD was diagnosed at a mean age of 8.1 years (3.0–14.7) in children with JIA as compared to 6.1 years (2.9–10.0) in controls. According to the modified Harris Hip Score (mHHS), four children with JIA and all controls had an excellent result. Regarding the fragmentation severity and the duration of each stage, we found no differences using the lateral pillar and modified Elizabethtown classification. Five hips were classified as Stulberg I/II, two hips as Stulberg III, and one hip as Stulberg V with no evidence of hip dysplasia or severe overcoverage in either group. Conclusions: The radiological outcome of LCPD did not differ between both groups, while the clinical outcome was slightly better in controls. Physicians should be aware that children with LCPD may have JIA too. In suspicious cases, further investigations are recommended, and patients should be referred to pediatric rheumatologists.

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Section: Discussionmentioning

confidence: 98%

Does Juvenile Idiopathic Arthritis Affect the Course of Legg–Calvé–Perthes Disease? A Case-Control Study with a Mean Follow-Up of 8 Years

Ross

Foeldvari²,

Krajewski

et al. 2021

Children

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“…Coxa vara, LLD, limping, overgrowth, and impingement of the greater trochanter are not uncommon among patients who received the operations. To solve the problem, several surgeons ( 14 , 18 , 39 , 40 ) turned to the combined surgery and evaluated the outcomes to prove the effectiveness of this operative design.…”

Section: Discussionmentioning

confidence: 99%

Computer-assisted design model to evaluate the outcome of combined osteotomies in Legg-Calvé-Perthes disease

Zhang

et al. 2022

Front. Pediatr.

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ObjectiveThe current study aims to conduct a quantitative dynamic analysis of hip morphology using a computer-assisted design (CAD) model to evaluate the combined pelvic and femoral osteotomies in the treatment of Legg-Calvé-Perthes disease (LCPD).Materials and methodsCAD models of patients with unilateral LCPD treated by combined pelvic and proximal femoral osteotomies were established based on the data of CT scan, on which morphological parameters were measured. Shape difference analysis of normal hips was adopted to locate the most apparent displacement and the main strain on the surface of the proximal femur.ResultsFifteen patients were included, and the mean age of receiving operation was 6.63 years old. There were 10 hips rated as Herring type C, and the rest were type B. Compared with the normal side, the affected hip joints have a longer distance between femoral head and acetabular sphere. The difference of coverage area of the femoral head surface and femoral head volume between the affected and normal sides was bigger compared with the preoperative model, respectively. The changes in the acetabular radius and the area of the surface were not apparent, pre-, and post-operatively. The displacement was mainly on superior and lateral superior portions of the femoral head where the stresses were concentrated.ConclusionCombined pelvic and femoral osteotomies could effectively improve the superior and superior–posterior area of acetabulum containment with increased femoral head volume. CAD model and shape difference analysis can provide a better understanding of deformations of LCPD and more information for surgical planning and evaluation of treatment outcomes.

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“… 31 Proximal femoral (derotating) varus osteotomies as well as pelvic osteotomies or combined osteotomies are implemented successfully. 33 , 34 …”

Section: Discussionmentioning

confidence: 99%

“…31 Proximal femoral (derotating) varus osteotomies as well as pelvic osteotomies or combined osteotomies are implemented successfully. 33,34 In hip joints with an improvement of containment postoperatively, an aggravation of containment may appear again with the need for further operative treatment. In this context, follow-up sonography for containment assessment is uncomplicated and it is not disturbed by osteosynthesis material.…”

Section: Discussionmentioning

confidence: 99%

MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment

Jandl

Schmidt

Schulz

et al. 2018

Journal of Children's Orthopaedics

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Abstract:PurposeThe containment orientated treatment of Legg-Calvé-Perthes disease (LCPD) affected hip joints is broadly accepted in the literature. The prerequisite is early recognition of loss of containment. An often-used quantitative MRI containment parameter is the cartilaginous acetabulum-head-index (CAHI). Based on ultrasound (US), we analyzed the newly created ‘femoral head extrusion angle’ (HA) as a containment parameter in comparison with the CAHI in severe LCPD.MethodsIn a prospective study with 40 children (mean age 5.8 years sd 2.3) with unilateral LCPD classified as Catterall group III/IV, we measured the CAHI versus HA to assess the containment of the femoral head. HA in US was determined by the tangent from the bony acetabular rim to the cartilaginous cranio-lateral femoral head.ResultsThe HA was significantly higher in LCPD-affected hip joints (25° sd 7°) than in healthy ones (13° sd 5°; p < 0.001). Correlation analysis of all hip joints revealed a significant correlation between HA and CAHI (r = −0.69; p < 0.001). Hip joints with a low CAHI indicating loss of containment showed a higher HA in sonography.ConclusionThe results of our study suggest that the HA in US is a reliable containment parameter in severe LCPD with a HA > 22° defining a pathologic value. In comparison with the CAHI, HA measurement in ultrasound is easier than the assessment of various parameters to calculate an index. Frequent sonographical follow-up assessment in critical joints is an alternative if MRI is not available, helping to detect an impending loss of containment early enough.Level of EvidenceLevel II

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Outcome After Combined Pelvic and Femoral Osteotomies in Patients with Legg-Calvé-Perthes Disease

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 23 publications

References 27 publications

Does Juvenile Idiopathic Arthritis Affect the Course of Legg–Calvé–Perthes Disease? A Case-Control Study with a Mean Follow-Up of 8 Years

Does Juvenile Idiopathic Arthritis Affect the Course of Legg–Calvé–Perthes Disease? A Case-Control Study with a Mean Follow-Up of 8 Years

Computer-assisted design model to evaluate the outcome of combined osteotomies in Legg-Calvé-Perthes disease

MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment

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