.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.jpg)
Radiological Outcome of Shelf Osteotomy in Legg Calve Perthes Disease.
Abstract
Background: Management of Perthes disease has many controversies. The main goal of treatment is to recover the femoral head in normal shape and to reduce pain and stiffness, to improve range of motion, prevent extrusion and collapse of head, and prevent subsequent deformity. The aim of our study is to assess the early radiological outcome of Shelf osteotomy in patients with legg calve Perthes disease
Methodology This case series was conducted at the Department of Orthopedics Surgery, Khyber Teaching hospital, Peshawar, in the period from February 2022 to Jan 2023. Twenty cases were included in the study. Clinical evaluation was done by using Modified Sundt criteria. Radiological parameters were followed up at 6 month.
Results: A total of 20 cases were analyzed, out of which 16 patients were males (80%) and four were females (20%). The mean age at onset of disease was 8.5 years (range: 8 years to 10 years). Pre-operatively, two (10%) patients were on the initial stage and 18 (90%) patients were on the fragmentation stage (12 (60%) cases classified as lateral pillar group B and 6(30%) cases classified as group B/C). Patients were followed up for 6 months. Clinically, 15 cases (85%) were found as good according to modified Sundt criteria, 4 cases (15%) were found as fair and one was found as poor. All the radiological parameters improved significantly.
Conclusion: We recommend shelf acetabuloplasty for the management of early stages of LCPD in patients with onset of the disease over eight years. This protocol of management yields favorable clinical and radiological results.
References
Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E. Legg-Calvé-Perthes disease overview. Orphanet J Rare Dis. 2022; 17(1):125.
Herring JA, Kim HT, Browne R. Legg-Calvé-Perthes disease: part II: prospective multicenter study of the effect of treatment on outcome. JBJS. 2004; 86(10):2121-34.
Kim HK, Herring JA. Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin N Am. 2011; 42(3):285–295.
Hsu JE, Baldwin KD, Tannast M, Hosalkar H. What is the evidence supporting the prevention of osteoarthritis and improved femoral coverage after shelf procedure for Legg-Calvé-Perthes disease? Clin Orthop Relat Res. 2012;470(9):2421-30.
Wright DM, Perry DC, Bruce CE. Shelf acetabuloplasty for Perthes disease in patients older than eight years of age: an observational cohort study. Journal of Pediatric Orthopaedics B. 2013;22(2):96-100.
Li WC, Xu RJ. Lateral shelf acetabuloplasty for severe Legg-Calvé-Perthes disease in patients older than 8 years: A mean eleven-year follow-up. Medicine (Baltimore). 2016; 95(45):5272.
Maleki A, Qoreishy SM, Bahrami MN. Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review. Interact J Med Res. 2021 May 3;10(2):e27075.
Vukasinovic Z, Spasovski D, Vucetic C, Cobeljic G, Zivkovic Z, Matanovic D. Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease. International orthopaedics. 2009; 33(5):1377-83.
Bursal A, Erkula G. Lateral shelf acetabuloplasty in the treatment of Legg–Calvé Perthes disease. Journal of Pediatric Orthopaedics B. 2004;13(3):150-2.
Kollitz KM, Gee AO. Classifications in brief: the Herring lateral pillar classification for Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 2013; 471(7):2068-72.
Holm AGV, Reikerås O, Terjesen T. Painless period after Spitzy shelf operation for residual hip dysplasia-A long-term study of 47 children and young adults. J Orthop. 2018;15(1):196-200.
Xiao YB, Du W, Wu PF, Qing LM, Yu F, Tang JY. Pedicled iliac bone flap grafting in the treatment of late presentation Legg-Calvé-Perthes disease. Front Surg. 2023; 10:926109.
Carsi B, Judd J, Clarke NM. Shelf acetabuloplasty for containment in the early stages of Legg-Calve-Perthes disease. J Pediatr Orthop. 2015 ;35(2):151-6.
Caldaci A, Testa G, Dell'Agli E, Sapienza M, Vescio A, Lucenti L, Pavone V. Mid-Long-Term Outcomes of Surgical Treatment of Legg-Calvè-Perthes Disease: A Systematic Review. Children (Basel). 2022 27;9(8):1121.
Grzegorzewski A, Szymczak W, Sibi?ski M, Borowski A, Synder M. Choroba Perthesa po dziewiatym roku zycia w chwili zachorowania [Perthes disease with onset after nine years of age]. Chir Narzadow Ruchu Ortop Pol. 2006; 71(6):447-52.
Huang MJ, Huang SC. Surgical treatment of severe perthes disease: comparison of triple osteotomy and shelf augmentation. J Formos Med Assoc. 1999; 98(3):183-9.
Kuwajima SS, Crawford AH, Ishida A, Roy DR, Filho JL, Milani C. Comparison between Salter's innominate osteotomy and augmented acetabuloplasty in the treatment of patients with severe Legg-Calvé-Perthes disease. Analysis of 90 hips with special reference to roentgenographic sphericity and coverage of the femoral head. J Pediatr Orthop B. 2002; 11(1):15-28.
