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Interlocking triple pelvic osteotomy in severe Legg-Calvé-Perthes disease
Deepak Kumar1, C E Bache, J N O'Hara
1Royal Orthopaedic Hospital and the Children's Hospital, Birmingham, England. suryashakti@hotmail.com
Insights
Triple pelvic osteotomy offers promising early results for severe Legg-Calvé-Perthes disease, improving hip function and joint alignment. This surgical technique provides stability, enabling early weight-bearing in pediatric patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Hip Preservation Surgery
Background:
- Severe Legg-Calvé-Perthes disease presents significant challenges in pediatric hip management.
- Containment of the subluxed femoral head is crucial for long-term outcomes.
- Traditional surgical methods may have limitations in stability and early mobilization.
Purpose of the Study:
- To evaluate the clinical, functional, and radiologic outcomes of triple pelvic osteotomy in patients with severe Legg-Calvé-Perthes disease.
- To assess the efficacy of a novel interlocking iliac osteotomy technique.
- To compare the results with previously reported surgical procedures for femoral head containment.
Main Methods:
- Review of 21 patients (mean age 7 years 7 months) with severe Legg-Calvé-Perthes disease (Herring group B and C).
- Surgical intervention using a new technique of interlocking iliac osteotomy.
- Assessment of clinical, functional (Harris score, range of motion), and radiologic parameters (acetabular head index, center-edge angle) at an average follow-up of 30 months.
Main Results:
- Significant average gains observed: Harris score (34.3), acetabular head index (18%), center-edge angle (22 degrees).
- Average improvements in range of motion: abduction (17 degrees), internal rotation (12 degrees), flexion (28 degrees).
- The interlocking technique provided extra stability and allowed early weight bearing.
Conclusions:
- Triple pelvic osteotomy, particularly with the interlocking iliac osteotomy technique, demonstrates promising early results for severe Legg-Calvé-Perthes disease.
- The procedure effectively improves hip function and joint congruency, exceeding results of other single surgical procedures.
- While longer follow-up is needed for mature outcomes, early findings support its use for femoral head containment.
Abstract:
The authors reviewed 21 patients who underwent triple pelvic osteotomy for severe Legg-Calvé-Perthes disease to evaluate their clinical, functional, and radiologic results. The mean age at presentation was 7 years 7 months (range 5-11 years). Seventeen hips were Herring group C and 5 were group B. All of them had "at risk" radiologic signs. A new technique of interlocking iliac osteotomy was used to provide extra stability, allow early weight bearing, and prevent inadvertent retroversion. The average period of follow-up was 30 months (range 1-5 years). The average gain in Harris score was 34.3 (range 4-55). The average gain in acetabular head index was 18% and that in center-edge angle was 22 degrees, more than reported for any other single surgical procedure for containment of the subluxed femoral head. Average gains in abduction, internal rotation, and flexion were 17 degrees, 12 degrees, and 28 degrees respectively. Longer follow-up is required to see the results at maturity, but the early results are promising.