Legg-Calvé-Perthes disease treatment by augmentation acetabuloplasty

• Published in: Orthopaedics & traumatology, surgery & research Vol. 96; no. 2; pp. 166 - 174
• Main Authors: Pecquery, R, Laville, J.-M, Salmeron, F
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-04-2010
• Subjects: Acetabulum - surgery; Child; Child, Preschool; Female; Humans; Legg-Calve-Perthes Disease - diagnostic imaging; Legg-Calve-Perthes Disease - surgery; Legg-Calvé-Perthes disease; Male; Orthopedics; Osteotomy; Radiography; Retrospective Studies; Shelf acetabuloplasty; Surgery; Legg-Calvé-Perthes disease; Shelf acetabuloplasty
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2009.09.016

Summary Introduction Classical surgical treatments for Legg-Calvé-Perthes (LCP) disease are pelvic or femoral osteotomies, which are not without complications and inconvenience for the patient. An effective, relatively undamaging surgical alternative would improve this disease treatment. Hypothesis Augmentation acetabuloplasty using shelf acetabuloplasty is a recognized treatment for LCP disease, but its results have never been assessed in view of Herring's lateral pillar classification, the current reference in determining the prognosis of this disease. Assessment of its efficacy based on this system is therefore needed. Material and methods Over 15 years, 21 patients underwent shelf acetabuloplasty. Included in the study were children with a progressively subluxating femoral head and classified minimum grade B in the lateral pillar classification. The last follow-up had to be at least 12 months after surgery and include a clinical examination as well as an AP pelvic X-ray. Results The mean follow-up was 4 years and 3 months. Only two complications occurred, one of which required surgical revision. Shelf acetabuloplasty was considered effective (contained and Stulberg 1 or 2) in 13 cases and ineffective (lysed or Stulberg 3, 4, or 5) in eight cases. Discussion The lateral pillar classification demonstrated its high value in LCP disease in correlation with symptom onset. This series shows that at the medium term, shelf acetabuloplasty is as effective as pelvic or femoral osteotomies for children of any age and any level of disease severity, with fewer complications and less inconvenience for the patient. Level of evidence : Level IV. Therapeutic retrospective study