Shelf acetabuloplasty for reconstructive or salvage surgical treatment in Legg-Calvé-Perthes disease

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Abstract

Background:

Treatment for Legg-Calvé-Perthes (LCP) disease remains controversial. When containment is not possible, salvage procedures have been used to treat symptomatic LCP disease.

Methods:

The purpose of this study was to assess the effectiveness of shelf acetabuloplasty (SA) for treatment of patients with symptomatic Legg-Calvé-Perthes (LCP) disease. A retrospective review of 17 patients with LCP disease treated by SA was conducted. The mean age at diagnosis was 7 yr, the mean age at SA was 9 yr, and the mean age at final follow-up was 14 yr. Surgery was offered to provide femoral head coverage and pain relief. Preoperative range of motion (ROM) and radiographs were evaluated. Radiographs, ROM, and Adolescent (parent report) Outcomes Data Collection Instrument (PODCI) outcomes were done at final follow-up. The lateral pillar classification of Herring was assessed preoperatively. The Stulberg classification was determined at final follow-up.

Results:

Preoperatively, 10 patients were Herring B, two were Herring B/C, and five were Herring C. Significant improvement was seen at final follow-up in all radiographic parameters that document improved femoral head coverage. No change was seen in the lateral acetabular shape (LAS) or the articulotrochanteric distance (ATD). Six hips at final visit were Stulberg 1 or 2 (35%), six hips were Stulberg 3 (35%), and five hips were Stulberg 4 or 5 (30%). All PODCI outcomes were slightly below normal, except happiness rated slightly above normal. Sixteen of 17 patients would recommend SA to others.

Conclusions:

SA remains a viable option for successful treatment during any stage of symptomatic LCP disease.

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