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Innominate osteotomy in Perthes' disease. A radiological survey of results
Insights
Innominate osteotomy effectively treats Perthes' disease affecting the entire femoral head in children. This surgical procedure improves femoral head shape and acetabular coverage, reducing subluxation risks.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
- Pediatric Hip Conditions
Background:
- Perthes' disease is a hip condition affecting children, characterized by the temporary loss of blood supply to the femoral head.
- When Perthes' disease involves the entire femoral head, treatment aims to maintain its spherical shape and ensure adequate acetabular coverage.
- Innominate osteotomy is a surgical technique considered for managing complex cases of Perthes' disease.
Purpose of the Study:
- To evaluate the efficacy of innominate osteotomy in treating Perthes' disease involving the whole femoral head.
- To assess the impact of innominate osteotomy on femoral head morphology, acetabular coverage, and hip joint stability.
- To determine the long-term outcomes and benefits of this surgical intervention in pediatric patients.
Main Methods:
- A retrospective review of 36 children with Perthes' disease treated with innominate osteotomy.
- Radiographic analysis of pre- and post-operative images to assess femoral head shape, acetabular index (CE angle), and Shenton's line integrity.
- Correlation of surgical outcomes with initial disease presentation and radiographic parameters.
Main Results:
- Innominate osteotomy maintained the circular shape of pre-operatively spherical femoral heads.
- Over 50% of pre-operatively deformed femoral heads became spherical post-osteotomy.
- Ninety-two percent of hips achieved a CE angle of 25 degrees or more, indicating improved acetabular coverage.
- Shenton's line integrity was maintained in hips where it was initially intact and restored in 11 out of 14 hips with pre-operative disruption.
Conclusions:
- Innominate osteotomy is a valuable surgical option for Perthes' disease affecting the entire femoral head.
- The procedure significantly enhances acetabular coverage and promotes femoral head remodeling.
- Restoration of hip joint congruity and stability is a key benefit of innominate osteotomy in this condition.
Abstract:
Perthes' disease involving the whole of the femoral head in 36 children was treated by innominate osteotomy. Radiographs of all cases were reviewed to see the effect of the osteotomy on the shape, the degree of acetabular cover and any subluxation of the diseased femoral head. All femoral heads which were circular before operation remained so, and over half of the previously deformed heads became circular after the osteotomy. The improved acetabular cover provided by the osteotomy resulted in a CE angle of 25 degrees or more in 92% of hips. Possible subluxation of the femoral head was studied by inspecting Shenton's line. If this was intact before operation it remained so; of the 14 which were broken before operation, 11 were restored to normal after osteotomy. We conclude that innominate osteotomy is a worthwhile procedure for Perthes' disease involving the whole of the femoral head.