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Braun S, Adolf S, Brenneis M, Boettner F, Meurer A. Legg-Calvé-Perthes disease- surgical treatment options. Arch Orthop Trauma Surg 2025; 145:186. [PMID: 40072635 PMCID: PMC11903597 DOI: 10.1007/s00402-025-05801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 03/01/2025] [Indexed: 03/14/2025]
Abstract
Legg-Calvé-Perthes disease (LCPD), is a rare avascular osteonecrosis of the proximal femur usually occurring in children between 5 and 10 years of age. The cause of ischemia leading to necrosis of the femoral head remains unknown. The goal of surgical treatment for LCPD is to improve the containment of the femoral head to restore the function of the hip joint and prevent further damage to the femoral head leading to premature hip osteoarthritis. Although a causal therapy is not available, the main aim is to maintain or restore the containment of the affected hip joint. The specific surgical treatment depends on the patient's age at onset, the stage, and severity of the disease. In early stages of the disease, the most common surgical option is a containment-restoring procedure such as femoral varus osteotomy (FVO), Salter's innominate osteotomy (SIO), and triple pelvic osteotomy (TPO). Moderate forms of LCPD show good results after treatment with either FVO or SIO, severe cases are recommended to be treated with FVO combined with either SIO or TPO to provide good outcomes. In later stages with increased damage to the femoral head, surgical options may include non-containment-restoring procedures to help symptom relief or restore anatomical and biomechanical features to a certain extend e.g., femoral valgus extension osteotomy or trochanter apophyseodesis. Due to the complexity of surgical interventions and the challenging nature of LCPD it is essential to consult with an experienced surgeon in pediatric orthopedics to determine the best treatment course for the patient.
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Emara KM, Diab RA, Emara AK, Eissa M, Gemeah M, Mahmoud SA. Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease. World J Orthop 2023; 14:328-339. [PMID: 37304198 PMCID: PMC10251266 DOI: 10.5312/wjo.v14.i5.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The treatment of late stages of Legg-Calvé-Perthes disease (LCPD) is controversial. Although the concept of femoral head containment is a well-established technique of treatment, its use remains debatable in the late stages of the disease, as it does not improve symptoms in terms of limb length discrepancy and gait. AIM To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease. METHODS From 2000 to 2007, 36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion (ROM) variables. The Mose classification was also assessed at the last follow-up to reflect possible remodeling. The patients were 8 years old or older at the time of surgery, in the post-fragmentation stage, and complaining of pain, limited ROM, Trendelenburg gait, and/or abductor weakness. RESULTS The preoperative IOWA score (average: 53.3) markedly improved at the 1-year post follow-up period (average: 85.41) and then slightly improved at the last follow-up (average: 89.4) (P value < 0.05). ROM improved, with internal rotation increased on average by 22° (from 10° preoperatively to 32° postoperatively) and abduction increased on average by 15.9° (from 25° preoperatively to 41° postoperatively). The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period. The tests used were the paired t-test and Pearson correlation test, where the level of significance was a P value less than 0.05. CONCLUSION Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.
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Affiliation(s)
- Khaled M Emara
- Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
| | - Ramy Ahmed Diab
- Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 9500, United States
| | - Mohamed Eissa
- Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
| | - Mostafa Gemeah
- Health Care Innovation Program, Arizona State University, Tempe, AZ 85287, United States
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Abstract
BACKGROUND Although hinge abduction is recognized as an important finding in children with Legg-Calvé-Perthes disease, variable diagnostic criteria exist. The purpose of this study was (1) to test the interobserver and intraobserver agreement of the current definition of hinge abduction and (2) to develop consensus regarding key diagnostic features that could be used to improve our diagnostic criteria. METHODS Four orthopaedic surgeons with subspecialty pediatric hip interest independently assessed 30 randomly ordered cases of Legg-Calvé-Perthes disease. Each case included 2 fluoroscopic images of hip arthrograms (anteroposterior and abduction views). Surgeons graded the cases in a binary manner (hinge/no-hinge) on 2 separate occasions separated by a 4-week interval. Following reliability testing and comprehensive review of the literature, consensus-building sessions were conducted to identify key diagnostic features. Surgeons then regraded a new series of cases. Interobserver and intraobserver agreement between first/second and third/fourth readings were assessed using the Fleiss κ. RESULTS Interobserver κ for hinge abduction between the first and second surveys was 0.52 (with 0.41 to 0.60 considered moderate agreement), compared with 0.56 for the third and fourth surveys. First and second reading intraobserver agreement ranged from 0.59 to 0.83 compared with 0.75 to 1.00 for third and fourth reading. Consensus sessions identified several key diagnostic factors including: adequate visualization of the labral contour and ability of the lateral epiphysis to slip below the chondrolabral complex in abduction. Medial dye pooling, often due to asphericity of the femoral head, was not found to be a useful diagnostic criterion. CONCLUSIONS Despite a combined experience of over 70 years among the reviewers, we found just slightly better than 50:50 agreement in what constitutes hinge abduction. Consensus discussions did improve our agreement but these modest changes emphasize how difficult it is to develop reliable diagnostic criteria for hinge abduction. As a result, we caution against using hinge abduction as an inclusion criteria or outcome measure for research purposes, as the diagnostic agreement can be inconsistent. LEVEL OF EVIDENCE Level III-diagnostic study.
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Ibrahim T, Little DG. The Pathogenesis and Treatment of Legg-Calvé-Perthes Disease. JBJS Rev 2018; 4:01874474-201607000-00004. [PMID: 27509329 DOI: 10.2106/jbjs.rvw.15.00063] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Legg-Calvé-Perthes disease is a childhood hip condition in which the blood supply to the capital femoral epiphysis is interrupted, causing osteonecrosis and chondronecrosis that lead to progressive deformity of the femoral head and secondary degenerative osteoarthritis in later life. The etiology of Legg-Calvé-Perthes disease remains unclear, with both biological and mechanical factors playing important roles in the pathogenesis of the condition. The treatment of Legg-Calvé-Perthes disease remains controversial but is dependent on several salient factors, including the age at clinical onset, the extent of epiphyseal involvement, the stage of the disease, and the degree of femoral head deformity. The literature supports operative containment treatment in the early stage of disease. Such treatment has led to improved femoral head sphericity with better patient outcomes in multicenter prospective cohort studies. The number of hips that need to be treated operatively in order to achieve a modest treatment effect remains high. Multicenter prospective cohort studies have shown that 6 to 7 patients need to be managed to create 1 spherical femoral head that would not have otherwise occurred.
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Affiliation(s)
- Talal Ibrahim
- Orthopaedic Research and Biotechnology, Department of Orthopaedic Surgery, Children's Hospital at Westmead, Sydney, Australia.,Department of Orthopaedic Surgery, Hamad General Hospital, Doha, Qatar
| | - David G Little
- Orthopaedic Research and Biotechnology, Department of Orthopaedic Surgery, Children's Hospital at Westmead, Sydney, Australia
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Anteromedial wedge reduction osteotomy
for the treatment of femoral head deformities. Hip Int 2014; 23:281-6. [PMID: 23475419 DOI: 10.5301/hipint.5000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 02/04/2023]
Abstract
Aspherical femoral head deformity has poor a prognosis which can lead to early arthritic changes in young adults. The intraartricular anteromedial wedge reduction osteotomy restores sphericity of the femoral head.
We performed seven anteromedial wedge reduction osteotomies. Clinical indications were pain, limp and restriction of movement of the hip joint. The mean age at time of the surgery was 13.3 years. The aetiology of the femroal head deformity was Perthes disease in six patients and in one patient, multiple epiphyseal dysplasia. All seven hips were classified as Stulberg V before surgery.
At a mean follow-up of 17.4 months the Harris hip score increased from a mean of 55.4 preoperatively to a mean of 84.8 postoperatively. The final results were Stulberg IV in one hip, Stulberg III in four hips and Stulberg II in two hips postoperatively. The capital diaphyseal ratio dropped from average of 1.57 preoperatively to 1.21 postoperatively. No signs of osteonecrosis were recorded. One patient suffered a subluxation of the femoral head.
The anteromedial wedge reduction osteotomy has good short-term results in aspherical incongruent hips.
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LCP 140° Pediatric Hip Plate for fixation of proximal femoral valgisation osteotomy. J Child Orthop 2014; 8:29-35. [PMID: 24488843 PMCID: PMC3935024 DOI: 10.1007/s11832-014-0550-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 01/07/2014] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Femoral osteotomy is one of the most widely performed reconstructive operations in pediatric orthopedic surgery. Many implants for fixation have been used, but so far there is no literature about the application and outcome of the LCP 140° Pediatric Hip Plate for proximal femoral valgisation in children. METHODS Data of patients with a valgisation of the proximal femur using the LCP 140° Pediatric Hip Plate between February 2011 and July 2012 were retrospectively collected and analyzed. RESULTS We included 10 patients (11 hips) with a mean follow-up of 15.3 ± 6.3 months (range 5.6-23 months). The mean age was 9.6 ± 1.2 years (range 7.3-11.8 years) with a mean hospital stay of 5.2 ± 1.7 days (range 3-9 days). Callus formation was observed in all cases at 6 weeks postoperative control and consolidation was shown after a mean time of 14.1 ± 2.3 weeks (range 12.1-19.1 weeks). There was no delayed union or any case of non-union in our series. The stability of the operative reduction including the corrected neck-shaft angle (mean 19° ± 7.9°; range 10.5°-38.5°) was maintained during the follow-up period. No cases of recurrence (varisation) or complications requiring further treatment or revision were observed. CONCLUSIONS In our series, the 140° LCP Pediatric Hip Plate was shown to be safe and applicable in the clinical setting with good results. We therefore consider this device to be valuable for the correction of pathologic varus conditions of the proximal femur in children.
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Abstract
BACKGROUND The authors have performed valgus femoral osteotomy (VFO) with rotational and sagittal components for Legg-Calvé-Perthes disease hips with hinge abduction. We analyzed skeletally mature patients to determine: (1) whether VFO improved hip function; (2) whether favorable radiographic remodeling of the hip occurred; and (3) whether any clinical or radiographic factors were associated with remodeling of femoral head deformity. METHODS Thirty-one patients (31 hips, 25 boys and 6 girls) who underwent VFO between 1986 and 2007, and subsequently followed until skeletal maturity constituted the study cohort. The mean age at surgery was 9.4 years (range, 3.5 to 15 y) and the mean age at the most recent follow-up was 20.2 years (range, 14.6 to 28.3 y). Clinical outcomes were evaluated using Iowa Hip Scores and ranges of hip motion. Radiographic outcomes were assessed with respect to the radiographic indices for femoral head deformity and subluxation. Clinical and radiographic parameters were analyzed to find correlations with the femoral head remodeling (preoperative to final follow-up changes in deformity index). RESULTS Iowa Hip Score improved from 71 (30 to 91) to 92 (76 to 100). Ranges of hip abduction, internal rotation, and external rotation increased. At last follow-up evaluations, mean Mose sphericity index of the femoral head was 4.2 mm (range, 0 to 13 mm) and femoral heads had 4 Stulberg type II, 21 type III, and 6 type IV deformity. Overall radiographic indices for femoral head deformity and subluxation did not change during follow-up period except decreased medial joint space, but greater amount of preoperative to final follow-up changes in deformity index was associated with younger age (<10 y) and earlier disease stages (fragmentation and early reossification stage) at time of surgery. CONCLUSIONS VFO modified to accommodate the various hinging patterns of Legg-Calvé-Perthes disease hips was found to beneficially improve hip function at skeletal maturity. Although overall radiographic remodeling was not definite, favorable remodeling of the femoral head can be expected when younger patients undergo this procedure at the fragmentation or early reossification stage.
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Kim HT, Gu JK, Bae SH, Jang JH, Lee JS. Does valgus femoral osteotomy improve femoral head roundness in severe Legg-Calvé-Perthes disease? Clin Orthop Relat Res 2013; 471:1021-7. [PMID: 23096935 PMCID: PMC3563831 DOI: 10.1007/s11999-012-2606-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 09/06/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many surgeons perform a varus femoral or Salter pelvic osteotomy in patients with Legg-Calvé-Perthes (LCP) disease. However, more severely deformed femoral heads show greater congruency in adduction rather than in abduction. Therefore, a valgus-(flexion) femoral osteotomy (VFO) seems preferable rather than a varus femoral or Salter pelvic osteotomy. QUESTIONS/PURPOSES We evaluated whether the VFO improves (1) femoral head roundness, (2) radiographic parameters reflecting hip subluxation, and (3) function. METHODS We treated 25 patients (25 hips; 18 lateral pillar C and seven B) in the late fragmentation stage by VFO. Seven patients had additional pelvic procedures. VFO was performed at a mean age of 9.8 years. Three hips were Stulberg Class II, 20 were Class III, and two were Class IV. The following components of femoral head roundness were calculated from preoperative MRI and final radiographs: lateral and medial head roundness (LHR and MHR); anterior and posterior head roundness (AHR and PHR); central head height; and the ratios MHR/LHR and PHR/AHR. Continuity of Shenton's line, medial gap ratio were evaluated. Function was determined with the Iowa hip score. Minimum followup was 3.1 years (mean, 6.3 years; range, 3.1-11.2 years). RESULTS All femoral head roundness measurements improved, with greatest improvement in the lateral and anterior head. Pillar C hips showed greater relative improvement than pillar B hips. The continuity of Shenton's line improved and the mean medial gap ratio decreased. Mean Iowa hip score improved from 71 before surgery to 90 at the last followup. CONCLUSIONS VFO appears to help the deformed femoral head in the fragmentation stage to remodel to fit the acetabulum. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hui Taek Kim
- />Department of Orthopaedic Surgery, Pusan National University Hospital, 1 Ga-10, Ami-Dong, Seo-Gu, Pusan, 602-739 Korea
| | - Ja Kyung Gu
- />Department of Medicine, Graduate School, Pusan National University, Pusan, Korea
| | - Sung Ho Bae
- />Department of Orthopaedic Surgery, Pusan National University Hospital, 1 Ga-10, Ami-Dong, Seo-Gu, Pusan, 602-739 Korea
| | - Jae Hoon Jang
- />Department of Orthopaedic Surgery, Pusan National University Hospital, 1 Ga-10, Ami-Dong, Seo-Gu, Pusan, 602-739 Korea
| | - Jong Seo Lee
- />Department of Orthopaedic Surgery, Pusan National University Hospital, 1 Ga-10, Ami-Dong, Seo-Gu, Pusan, 602-739 Korea
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Louahem M'sabah D, Assi C, Cottalorda J. Proximal femoral osteotomies in children. Orthop Traumatol Surg Res 2013; 99:S171-86. [PMID: 23337439 DOI: 10.1016/j.otsr.2012.11.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/29/2012] [Indexed: 02/02/2023]
Abstract
The aim of proximal femoral osteotomies (PFO) in children is to restore normal anatomy and optimal joint congruency to prevent medium and long-terms degenerative deterioration of the hip. They play an important role in the treatment of neurological subluxations or dislocations of the hip. Advances in modern imaging and surgical techniques have improved understanding of the anatomical factors associated with a number of disorders of the growing hip and their sequelae. The indications for isolated PFO or associated with other intra- or extraarticular procedures have become more rational and better adapted to the various architectural defects and the femoroacetabular impingements. Two types of osteotomies are described: intertrochanteric osteotomies (varus and valgus correction, valgisation, flexion, extension), and osteotomies of the greater trochanter, either simple or double with lengthening of the femoral neck. Primary stability of the osteosynthesis is the major problem, as it is often affected by osteopenia. The development of new implants (LCP plate) avoids this inconvenience, resulting in geometrically precise osteotomies and a more stable fixation. Even when it is correctly performed, articular congruence is not always managed by PFO alone, it is sometimes necessary to associate acetabular procedures.
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Affiliation(s)
- D Louahem M'sabah
- Service de chirurgie orthopédique pédiatrique, CHU Lapeyronie, 371 avenue du Doyen-Gaston-Giraud, Montpellier cedex 5, France.
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Valgus extension femoral osteotomy to treat "hinge abduction" in Perthes' disease. J Child Orthop 2012; 6:463-9. [PMID: 24294308 PMCID: PMC3511687 DOI: 10.1007/s11832-012-0453-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/02/2012] [Indexed: 02/03/2023] Open
Abstract
PURPOSE "Hinge abduction" is a complication of Perthes' disease caused by impingement of the extruded superolateral portion of the femoral head against the lateral lip of the acetabulum. Catterall first described femoral valgus extension osteotomy (VGEO) to treat this condition. We report the results of this operation in 16 cases of Perthes' disease with "hinge abduction". METHODS Sixteen hips in 16 patients affected by Perthes' disease and "hinge abduction" were operated on at a mean age of 10.1 years and followed up an average of 6.5 years later. Before surgery, the mean Iowa hip score was 44.4 points. Preoperative radiographs were taken with the affected hip in maximum adduction in order to calculate the amount of valgus correction. The osteotomy was performed between the greater and the lesser trochanter, and it was fixed with a hip plate. RESULTS All the osteotomies healed uneventfully. At follow-up, no patient complained of pain and hip abduction ranged from 20° to 45°. Four out of the 16 patients had a moderate limp, and 12 had an improvement in gait pattern compared to preoperatively. At follow-up, the Iowa hip score totaled a mean of 83.6 points, with a statistically significant improvement in comparison to the preoperative evaluation. At follow-up, two hips were classified as Stulberg II-III, ten hips as Stulberg III, and four as Stulberg IV. CONCLUSIONS In our hands, VGEO was an effective procedure to treat "hinge abduction" in severe Perthes' disease with satisfactory results. The main limitation of our study is its short follow-up.
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Low early failure rates using a surgical dislocation approach in healed Legg-Calvé-Perthes disease. Clin Orthop Relat Res 2012; 470:2441-9. [PMID: 22125243 PMCID: PMC3830106 DOI: 10.1007/s11999-011-2187-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip deformity secondary to Legg-Calvé Perthes disease (LCPD) may result in femoroacetabular impingement (FAI) and ultimately osteoarthritis. Observations made with the surgical hip dislocation approach have improved our understanding of the pathologic mechanics of FAI. However, owing to concerns about complications related to the vascularity, the role of surgical hip dislocation in the treatment of healed LCPD remains controversial. QUESTIONS/PURPOSES We present an algorithm to treat deformities associated with healed LCPD and asked (1) whether femoral head-neck osteochondroplasty and other procedures performed with the surgical hip dislocation approach provide short-term clinical improvement; and (2) is the complication rate low enough to be acceptable. METHODS We retrospectively reviewed 29 patients (19 males, 10 females; mean age, 17 years; range, 9-35 years) with symptomatic LCPD between 2001 and 2009. All patients underwent a surgical hip dislocation approach and femoral head-neck osteochondroplasty and 26 patients had 37 additional procedures performed. Clinical improvement was assessed using the WOMAC index. The minimum followup was 12 months (mean, 3 years; range, 12-70 months). RESULTS WOMAC scores improved at final followup (8 to 4 for pain, 21 to 13 for function, and 4 to 2 for the stiffness subscales). No patients had osteonecrosis, implant failure, deep infection, or nonunion. Three patients underwent THA at 1, 3, and 6 years after their index procedure. CONCLUSIONS Using the surgical hip dislocation approach as a tool to dynamically inspect the hip for causes of FAI, we were able to perform a variety of procedures to treat the complex deformities of healed LCPD. In the short term, we found improvement in WOMAC scores with a low complication rate.
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Abstract
It is of paramount importance to distinguish hips that may or may not be suitable for containment in the transitional stage (fragmentation to early reossification stage), because long-term clinical and radiological outcomes may be influenced by the choice of treatment. This article summarizes the definition of hinge abduction, pathoanatomy of hinge segment, assessment of hinge abduction, determination of reducible and irreducible hinge abduction, and treatment strategies for containable and uncontainable hips in the transitional stage.
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Hip arthrography under general anesthesia to refine the definition of hinge abduction in Legg-Calvé-Perthes disease. J Pediatr Orthop 2008; 28:614-8. [PMID: 18724196 DOI: 10.1097/bpo.0b013e3181842013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hinge abduction is widely accepted as a poor prognostic factor in Legg-Calvé-Perthes disease (LCPD), whereas the exact definition of hinge abduction remains ill defined. The purpose of this diagnostic study was to refine the definition of hinge abduction in LCPD using conventional hip arthrography under general anesthesia. METHODS Among 350 hips in 332 LCPD patients, we reviewed 92 hips in 90 patients (75 boys and 15 girls) who consecutively underwent arthrography under general anesthesia because of an expected poor prognosis. The mean age at LCPD onset was 8.2 years (range, 4-13 years). With respect to lateral pillar classification, 25 hips were classified as group B, 27 as B/C border, and 40 as C. Subluxation (>or=3-mm difference from unaffected side) was present in 81 (88%) of the 92 hips. The modified Waldenström classification was used for evaluating the radiographic stage of disease at the time of arthrography: 80 hips were classified as fragmentation stage and 12 as reossification stage. Hinge abduction was defined as an increased subluxation index in maximum abduction and/or a positive impingement sign. RESULTS Under this definition, 11% (10 hips) of the study group had hinge abduction. The range of abduction under general anesthesia (40 degrees) was significantly greater than in the awake condition (24 degrees, P < 0.0001). CONCLUSIONS The subluxation index and the impingement sign proved to be reliable indicators for diagnosing hinge abduction. Conventional arthrography remains useful. General anesthesia provided an analgesic effect and muscle relaxation. LEVEL OF EVIDENCE Level II (diagnostic study, development of diagnostic criteria on the basis of consecutive patients).
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Abstract
BACKGROUND This is a study to establish the role of surgery in late presenting hinge abduction following Legg-Calvé-Perthes disease. METHODS A prospective study was carried out involving 15 patients who underwent valgus femoral osteotomy for hinge abduction related to Perthes disease between 1995 and 2000. Surgery was performed by the senior author. There were 2 females and 13 males; in 6 cases, the left hip was affected, and in 9, the right. There were no cases of bilateral Perthes disease. The mean age at the time of surgery was 17 years and 9 months with an age range of 11 years to 32 years and 6 months. All patients were Stulberg grade 3 or 4 preoperatively. RESULTS The mean follow-up was 78 months (range, 61-95 months). The mean Harris hip score (HHS) preoperatively was 48 with a range of 29 to 75. At a mean of 22 months postoperatively, the HHS improved to a mean of 89 (range, 62-100) points (P < 0.01). There was no subsequent significant alteration in the HHS from the time of initial follow-up to final follow-up at 6.5 years. CONCLUSION This study illustrates the role of valgus femoral osteotomy in patients presenting late with hinge abduction, demonstrating that the initially early improvement in patient function stabilizes and does not alter at 6 years. LEVEL OF EVIDENCE Prospective study. Level 1.
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Hung SS, Lee ZL, Lee MY. Clinical application of rapid prototype model in pediatric proximal femoral corrective osteotomy. Orthopedics 2008; 31:72. [PMID: 19292166 DOI: 10.3928/01477447-20080101-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Proximal femoral deformities can occur in children as sequelae of several disorders such as hip joint infection or avascular necrosis of the femoral head. Early surgical correction of deformities promises a good result; however, limited exposure of the surgical field often creates difficulties for surgeons. Application of a rapid prototyping model for proximal femoral corrective osteotomy in children serves not only as a guide for surgical planning but also as a communication tool between physicians and patients.
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Affiliation(s)
- Shuo-Suei Hung
- Graduate School of Mechanical Engineering, Chang Gung University, Kwei Shan, Tao Yuan, Taiwan
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Eijer H, Podeszwa DA, Ganz R, Leunig M. Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes' disease. Hip Int 2006; 16:273-80. [PMID: 19219805 DOI: 10.1177/112070000601600406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hip pain and loss of motion in young adults with previous Legg-Calve-Perthes-Disease may be caused by anterior femoro-acetabular impingement. Eleven patients (12 hips) with the chief complaint of groin pain and significant proximal femoral deformity were treated. Gadolinium-enhanced magnetic resonance arthrography in ten patients indicated labral injury and adjacent acetabular cartilage lesions in nine hips. A surgical dislocation of each hip confirmed that there was impingement induced intra-articular injury consistent with the pathology indicated on the MRI. Reshaping of the femoral head, with correction of the femoral head/neck offset, and treatment of the acetabular rim pathology was performed for each hip in conjunction with other procedures for the proximal femur. Correction of the impingement and increased range of motion could be visualized intra-operatively. At a mean follow-up of 33 months, half of all patients were pain-free and all had improvement in pain compared with preoperatively. Ten patients had an improved range of motion and two a slight decrease. No additional necrosis following the dislocation of the femoral head was seen.;
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Affiliation(s)
- H Eijer
- Department of Orthopaedic Surgery, Sonnenhof Clinic, Bern, Switzerland.
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Abstract
Femoral head deformity with flattening and lateral protrusion can occur secondary to epiphyseal dysplasia or avascular necrosis of any aetiology in childhood. This deformity causes painful impingement of the lateral femoral head on the acetabular lip, a phenomenon known as hinge abduction. Twenty patients undergoing valgus osteotomy for hinge abduction were clinically and radiologically reviewed. The procedure corrected some leg shortening and improved the abduction range of the affected hip. Overall, 80% of patients did well. Valgus osteotomy is an effective procedure for relieving hinge abduction.
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Affiliation(s)
- Sanjeev Patil
- Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
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