Labral support shelf arthroplasty for the early stages of severe Legg-Calvé-Perthes disease

The best treatment for Legg-Calvé-Perthes disease remains unknown, and various methods of treatment have been shown to yield conflicting results. Treatment with a labral support shelf arthroplasty is ideal when an increased arc of the acetabulum is needed to contain an enlarged femoral head, when extension of the lateral border of the acetabulum is needed to prevent hinge subluxation, and when a larger surface area is needed for remodeling. Twenty patients with unilateral Catterall classes III and IV and lateral pillar groups B and C disease in the necrotic or fragmentation stage were treated with a shelf arthroplasty. Eleven hips demonstrated hinge subluxation. Success was defined as achievement of a round or oval femoral head, and failure was defined as a flat femoral head. Clinical examination evaluated the presence of pain, limp, and range of motion. Eighteen of the 20 hips (90%) had a successful result. Hinge subluxation was eliminated in all 11 hips. All 18 patients with a successful result had no pain, no limp, and a functional range of motion. The 2 hips considered a failure were in the oldest patients. Treatment with a labral support shelf arthroplasty fostered femoral head sphericity and prevented incongruence in hips otherwise at risk for poor results. Ninety percent of hips had a round or oval femoral head with no pain, no limp, and a functional range of motion.