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Triple innominate osteotomy for Legg-Calvé-Perthes disease in children: does the lateral coverage change with time?
Harish Hosalkar1, Ana Laura Munhoz da Cunha, Keith Baldwin
1Department of Orthopedic Surgery, Rady Children's Hospital, University of California-San Diego, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA. hhosalkar@rchsd.org
Insights
Triple innominate osteotomy (TIO) effectively contains the femoral head in Legg-Calvé-Perthes disease (LCPD). However, avoid overcorrection of the center-edge angle and acetabular roof arc angle to prevent pincer impingement.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Hip preservation surgery
Background:
- Triple innominate osteotomy (TIO) is a surgical technique for Legg-Calvé-Perthes disease (LCPD).
- TIO can potentially lead to overcoverage and pincer impingement.
- Assessing TIO's effectiveness and long-term consequences is crucial.
Purpose of the Study:
- To evaluate femoral head containment after TIO in Catterall Stages III and IV LCPD.
- To analyze changes in hip joint angles (CE angle, ARA, Sharp's angle) during growth.
- To determine the incidence of radiographic pincer impingement post-TIO.
Main Methods:
- Retrospective review of 20 TIOs in 19 children with Catterall Stages III/IV LCPD.
- Radiographic assessment by two blinded observers over a minimum 3-year follow-up.
- Measurement of femoral head extrusion index, CE angle, ARA, and Sharp's angle.
Main Results:
- All TIOs achieved femoral head containment.
- Eleven of 20 hips showed no pincer morphology at a mean 3.8-year follow-up.
- CE angle ≤44° and ARA >-6° correlated with no pincer morphology.
Conclusions:
- TIO successfully contains the femoral head in LCPD.
- Acetabular coverage angles change during skeletal maturation.
- Avoid CE angle >44° and ARA <-6° to prevent pincer morphology.
Background:
Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calvé-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement.
Questions/Purposes:
We therefore asked (1) whether TIO contained the femoral head in Catterall Stages III and IV of LCPD; (2) whether the center-edge (CE) angle, acetabular roof arc angle (ARA), and Sharp's angle changed during the growing years; and (3) what percentage of patients had radiographic evidence of pincer impingement beyond a minimum followup of 3 years.
Methods:
We identified 19 children who had 20 TIOs performed for Catterall Stages III and IV LCPD. Two blinded observers assessed sequential radiographs. Each observer made two sets of readings more than 2 weeks apart. Femoral head extrusion index, CE angle of Wiberg, ARA, and Sharp's angle were measured. Minimum followup was 3 years to document continued acetabular growth (mean, 3.8 years; range, 3-7 years).
Results:
All patients exhibited femoral head containment at last followup. Eleven of 20 hips demonstrated no radiographic evidence of pincer morphology beyond a minimum followup of 3 years (mean, 3.8 years). Patients with CE angle corrected to 44° or less and an ARA of greater than -6° after TIO did not demonstrate a pincer morphology at last followup.
Conclusions:
TIO resulted in femoral head containment in all cases. Lateral acetabular coverage changed during the growing years in all patients. Surgical correction beyond 44° of CE angle and -6° of ARA should be avoided to prevent pincer morphology later.