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Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy
Olivier Rosello1, Federico Solla1, Ioana Oborocianu1
1Paediatric Orthopaedic Unit, Paediatric Hospitals of Nice CHU-Lenval, Nice - France.
Insights
Triple pelvic osteotomy (TPO) offers superior outcomes for Legg-Calvé-Perthes disease (LCPD) compared to Chiari osteotomy. TPO demonstrated better radiologic and clinical results, including improved function and reduced pain.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Skeletal Dysplasias
Background:
- Legg-Calvé-Perthes disease (LCPD) requires intervention to prevent femoral head deformation.
- Surgical containment, particularly pelvic osteotomies, is the primary treatment approach.
- Common procedures include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy, and shelf procedures.
Purpose of the Study:
- To compare the clinical and radiologic outcomes of Chiari osteotomy versus triple pelvic osteotomy (TPO) in treating Legg-Calvé-Perthes disease (LCPD).
Main Methods:
- A retrospective review of 29 children with LCPD treated between 1980 and 2010.
- 19 patients underwent TPO, and 10 had Chiari osteotomy.
- Radiographic and clinical data, including preoperative and postoperative classifications (Catterall, Herring, Salter-Thompson, Stulberg), center-edge angle (CE), acetabular index (AI), and Harris Hip Score (HHS), were assessed by two independent observers.
Main Results:
- Average follow-up was 4.2 years, with comparable groups preoperatively.
- TPO group showed statistically significant improvements in Stulberg classification (p=0.01), acetabular index (AI) (p=0.002), pain (p=0.02), and function (p=0.01) via HHS.
- No significant differences were observed in the center-edge angle (CE) between the two groups.
Conclusions:
- Triple pelvic osteotomy (TPO) yielded superior radiologic and clinical outcomes compared to Chiari osteotomy in this series of LCPD patients.
- TPO demonstrated particular advantages in final Stulberg classification, pain reduction, and functional improvement.
- TPO is recommended as the preferred surgical option when indicated for LCPD treatment.
Introduction:
The goal of intervention in Legg-Calvé-Perthes disease (LCPD) is to prevent femoral head deformation by containing the head within the acetabulum. Currently, surgical containment methods are the mainstay of treatment, and pelvic osteotomies have been shown to be successful. They include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy and shelf procedure. The purpose of this study was to compare clinical and radiologic results for Chiari osteotomy and TPO in LCPD.
Methods:
29 children treated between 1980 and 2010 for LCPD in 2 centres were reviewed. 19 underwent TPO, and 10, Chiari osteotomy. Two independent observers assessed sequential radiographs and medical data. Each hip was preoperatively classed by clinical data, Catteral, Herring and Salter-Thompson classification, centre-edge angle (CE), and acetabular index (AI). The 2 groups were first tested for their comparability. After surgery the hips were classified by Stulberg classification, CE, AI, Harris Hip Score (HHS) and performance of further surgery. Chiari osteotomy and TPO have been secondary compared on these data by Wilcoxon test.
Results:
Average follow-up was 4.2 years. The 2 groups were comparable before surgery. At first and last follow-up examination, statistically significantly superior results in patients with TPO regarding Stulberg classification (p = 0.01), AI (p = 0.002), pain (p = 0.02) and function (p = 0.01) in the HHS score were found. No differences were noticed concerning CE angle.
Conclusions:
In our series, TPO provided better radiologic and clinical outcomes compared to Chiari osteotomy, specially concerning the final Stulberg classification. We concluded that TPO should be preferred when indicated.