Outcomes in Advanced Legg-Calvé-Perthes Disease Treated With the Staheli Procedure

Chang, Jen-Huei; Kuo, Ken N.; Huang, Su‐Cheng

doi:10.1016/j.jss.2009.09.056

Cited by 14 publications

(9 citation statements)

References 31 publications

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“…The increase in femoral head coverage and CE angle could provide better containment in the hip for remodeling of a new femoral head. Medial joint space ratio (a1/a2) decreased from 164.82% ± 8.39% to 116.25% ± 7.85% at the final follow-up ( P < 0.001), which is comparable with the results of Chang et al [9] Dimitriou et al and Huang et al [23,24] also noted a significant decrease in the medial joint space ratio of the femoral head. In addition, the mean Sharp angle decreased from 57.61 ± 4.21 degree to 44.37 ± 3.55 degree.…”

Section: Discussionsupporting

confidence: 86%

“…The percentage of acetabular coverage of the femoral head increased from 75.90% ± 7.64% to 113.73% ± 7.19%, a result that is consistent with those of another study that reported an increase from 74% to 98%. [9] Herring et al [22] reported an improvement in the coverage of the femoral head from 66% to 110%. Furthermore, the CE angle increased from 23.02 ± 7.47 degree to 46.33 ± 6.02 degree ( P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Chang et al [9] achieved a Stulberg classification of 1–2 in 33.3% of cases and 3 in 38.1%. Daly et al [25] reported that Stulberg grade 1–3 was achieved in 81.4% of patients, a similar result to ours (85.1%).…”

Section: Discussionmentioning

confidence: 99%

“…[7,8] When used as salvage surgery, it may provide relief from pain and benefit the involved hip via femoral head flattening, especially in older children. [4,9] It also improves the spherical remodeling of the femoral head and acetabulum by stimulating lateral acetabular growth. [10–12] …”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ren

2016

Medicine

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“…They reported 2 good results and 12 fair results with 3 patients requiring further operative intervention and concluded that the procedure was safe and effective for severe cases. 18 Chang et al 30 recently reported the outcomes for treating advanced LCP disease with the Staheli shelf acetabuloplasty. They noted a marked improvement of abduction motion at final follow-up and found that 33% of patients achieve spherical congruence of the hip with an ovoid femoral head and a further 38% achieved congruence with a mushroom-shaped femoral head.…”

Section: Discussionmentioning

confidence: 99%