Top

Published in:

01-01-2016 | Original Paper

Triple osteotomy of the pelvis for Legg-Calve-Perthes disease: a mean fifteen year follow-up

Authors: Régis Pailhé, Etienne Cavaignac, Jérôme Murgier, Jean Philippe Cahuzac, Jerôme Sales de Gauzy, Franck Accadbled

Published in: International Orthopaedics | Issue 1/2016

Abstract

Purpose

This study presents the results of a prospective consecutive cohort of patients with Legg-Calvé-Perthes disease (LCPD) operated with triple osteotomy of the pelvis (TOP) between 1989 and 2005. We attempted to determine whether the results of TOP remain stable with time and consequently lower the risk of subsequent osteoarthritis. The primary study aims were to determine the maintenance of head coverage and joint congruity, and functional outcomes of this surgery.

Methods

Forty-five patients with a mean follow-up of 15.2 years (range eight to 24) were included.

Results

At latest follow-up, two patients were lost to follow-up, and two required a surgical reoperation. Cumulative maintenance of head coverage and joint congruity rate for all TOP was 84.6 % (95 % CI: 82.3–90.6 %) at 15 years. Factors significantly associated with poor long-term results were the age at diagnosis and Greene index.

Conclusion

TOP in LCPD provides satisfactory and reproducible long-term clinical results.

Herring JA (2011) Legg-Calvé-Perthes disease at 100: a review of evidence-based treatment. J Pediatr Orthop 31:S137–S140. doi:10.1097/BPO.0b013e318223b52d PubMedCrossRef

Santore RF, Turgeon TR, Phillips WF, Kantor SR (2006) Pelvic and femoral osteotomy in the treatment of hip disease in the young adult. Instr Course Lect 55:131–144PubMed

Poul J, Vejrostová M (2001) Triple osteotomy of the pelvis in children and adolescents. Acta Chir Orthop Traumatol Cech 68:93–98PubMed

Conroy E, Sheehan E, O’Connor P et al (2010) Triple pelvic osteotomy in Legg-Calve-Perthes disease using a single anterolateral incision: a 4-year review. J Pediatr Orthop B 19:323–326. doi:10.1097/BPB.0b013e32833822a4 PubMedCrossRef

O’Connor PA, Mulhall KJ, Kearns SR et al (2003) Triple pelvic osteotomy in Legg-Calvé-Perthes disease using a single anterolateral incision. J Pediatr Orthop B 12:387–389. doi:10.1097/01.bpb.0000049565.52224.68 PubMedCrossRef

Hosalkar H, Munhoz da Cunha AL, Baldwin K et al (2012) Triple innominate osteotomy for Legg-Calvé-Perthes disease in children: does the lateral coverage change with time? Clin Orthop Relat Res 470:2402–2410. doi:10.1007/s11999-011-2189-z PubMedPubMedCentralCrossRef

Saran N, Varghese R, Mulpuri K (2012) Do femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calvé-Perthes disease? A meta-analysis. Clin Orthop Relat Res 470:2383–2393. doi:10.1007/s11999-012-2326-3 PubMedPubMedCentralCrossRef

Catterall A, Pringle J, Byers PD et al (1982) A review of the morphology of Perthes’ disease. J Bone Joint Surg (Br) 64:269–275

Herring JA, Neustadt JB, Williams JJ et al (1992) The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop 12:143–150PubMedCrossRef

10.

Sales de Gauzy J (2010) Pelvic reorientation osteotomies and acetabuloplasties in children. Surgical technique. Orthop Traumatol Surg Res 96:793–799. doi:10.1016/j.otsr.2010.07.004 PubMedCrossRef

11.

Le Coeur P (1965) Correction des défauts d’orientation de l’articulation coxofémorale par ostéotomie de l’isthme iliaque. Orthop Rev Chir 51:211–212

12.

Green NE, Beauchamp RD, Griffin PP (1981) Epiphyseal extrusion as a prognostic index in Legg-Calvé-Perthes disease. J Bone Joint Surg Am 63:900–905PubMed

13.

Dawson J, Fitzpatrick R, Carr A, Murray D (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg (Br) 78:185–190

14.

Lequesne M, de Seze (1961) False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies. Rev Rhum Mal Osteoartic 28:643–652PubMed

15.

Wiberg G (1939) Relation between congenital subluxation of the hip and arthritis deformans. Acta Orthop Scand 10:351–371. doi:10.3109/17453673909149515 CrossRef

16.

Tönnis D, Arning A, Bloch M et al (1994) Triple pelvic osteotomy. J Pediatr Orthop B 3:54CrossRef

17.

Nelson D, Zenios M, Ward K et al (2007) The deformity index as a predictor of final radiological outcome in Perthes’ disease. J Bone Joint Surg (Br) 89:1369–1374. doi:10.1302/0301-620X.89B10.18747 CrossRef

18.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedPubMedCentralCrossRef

19.

Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55:1629–1632PubMed

20.

Stulberg SD, Cooperman DR, Wallensten R (1981) The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 63:1095–1108PubMed

21.

Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

22.

Reinker KA (1996) Early diagnosis and treatment of hinge abduction in Legg-Perthes disease. J Pediatr Orthop 16:3–9PubMedCrossRef

23.

Joseph B, Mulpuri K, Varghese G (2001) Perthes’ disease in the adolescent. J Bone Joint Surg (Br) 83:715–720CrossRef

24.

Bankes MJ, Catterall A, Hashemi-Nejad A (2000) Valgus extension osteotomy for ‘hinge abduction’ in Perthes’ disease. Results at maturity and factors influencing the radiological outcome. J Bone Joint Surg (Br) 82:548–554CrossRef

25.

Yoo WJ, Choi IH, Moon HJ et al (2013) Valgus femoral osteotomy for noncontainable Perthes hips: prognostic factors of remodeling. J Pediatr Orthop 33:650–655. doi:10.1097/BPO.0b013e31829569c8 PubMedCrossRef

26.

Herring JA, Williams JJ, Neustadt JN, Early JS (1993) Evolution of femoral head deformity during the healing phase of Legg-Calvé-Perthes disease. J Pediatr Orthop 13:41–45PubMedCrossRef

27.

Joseph B, Nair NS, Narasimha Rao KL et al (2003) Optimal timing for containment surgery for Perthes disease. J Pediatr Orthop 23:601–606PubMedCrossRef

28.

Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis–what the radiologist should know. AJR Am J Roentgenol 188:1540–1552. doi:10.2214/AJR.06.0921 PubMedCrossRef

29.

Park K-W, Jang K-S, Song H-R (2013) Can residual leg shortening be predicted in patients with Legg-Calvé-Perthes’ disease? Clin Orthop Relat Res 471:2570–2577. doi:10.1007/s11999-013-3009-4 PubMedPubMedCentralCrossRef

30.

Wenger DR, Pring ME, Hosalkar HS et al (2010) Advanced containment methods for Legg-Calvé-Perthes disease: results of triple pelvic osteotomy. J Pediatr Orthop 30:749–757. doi:10.1097/BPO.0b013e3181f5a0de PubMedCrossRef

31.

Kumar D, Bache CE, O’Hara JN (2002) Interlocking triple pelvic osteotomy in severe Legg-Calvé-Perthes disease. J Pediatr Orthop 22:464–470PubMed

32.

Vukasinovic Z, Spasovski D, Vucetic C et al (2009) Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease. Int Orthop 33:1377–1383. doi:10.1007/s00264-009-0745-x PubMedPubMedCentralCrossRef

33.

Larson AN, Sucato DJ, Herring JA et al (2012) A prospective multicenter study of Legg-Calvé-Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Joint Surg Am 94:584–592. doi:10.2106/JBJS.J.01073 PubMedCrossRef

34.

McAndrew MP, Weinstein SL (1984) A long-term follow-up of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 66:860–869PubMed

35.

Terjesen T, Wiig O, Svenningsen S (2012) Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calvé-Perthes disease. Clin Orthop Relat Res 470:2394–2401. doi:10.1007/s11999-011-2181-7 PubMedPubMedCentralCrossRef

36.

Mirovsky Y, Axer A, Hendel D (1984) Residual shortening after osteotomy for Perthes’ disease. A comparative study. J Bone Joint Surg (Br) 66:184–188

37.

Grzegorzewski A, Synder M, Kozłowski P et al (2005) Leg length discrepancy in Legg-Calve-Perthes disease. J Pediatr Orthop 25:206–209PubMedCrossRef

38.

Van Der Geest IC, Kooijman MA, Spruit M et al (2001) Shelf acetabuloplasty for Perthes’ disease: 12-year follow-up. Acta Orthop Belg 67:126–131

39.

Parvizi J, Burmeister H, Ganz R (2004) Previous Bernese periacetabular osteotomy does not compromise the results of total hip arthroplasty. Clin Orthop Relat Res 423:118–122PubMedCrossRef

40.

Thompson GH (2011) Salter osteotomy in Legg-Calvé-Perthes disease. J Pediatr Orthop 31:S192–S197. doi:10.1097/BPO.0b013e318223b59d PubMedCrossRef

41.

Novais EN, Clohisy J, Siebenrock K et al (2011) Treatment of the symptomatic healed Perthes hip. Orthop Clin North Am 42:401–417. doi:10.1016/j.ocl.2011.05.003, viiiPubMedCrossRef

42.

Dora C, Mascard E, Mladenov K, Seringe R (2002) Retroversion of the acetabular dome after Salter and triple pelvic osteotomy for congenital dislocation of the hip. J Pediatr Orthop B 11:34–40PubMed

43.

Ganz R, Parvizi J, Beck M et al (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120. doi:10.1097/01.blo.0000096804.78689.c2 PubMed

44.

Tannast M, Macintyre N, Steppacher SD et al (2013) A systematic approach to analyse the sequelae of LCPD. Hip Int 23(Suppl 9):S61–S70. doi:10.5301/hipint.5000071 PubMedCrossRef

45.

Scher MAM, Jakim II (1991) Combined intertrochanteric and Chiari pelvic osteotomies for hip dysplasia. J Bone Joint Surg (Br) 73:626–631

46.

Hashemi-Nejad AA, Haddad FSF, Tong KMK et al (2002) Does Chiari osteotomy compromise subsequent total hip arthroplasty? J Arthroplasty 17:731–739PubMedCrossRef

47.

Peters CLC, Beck MM, Dunn HKH (2001) Total hip arthroplasty in young adults after failed triple innominate osteotomy. J Arthroplasty 16:8–8. doi:10.1054/arth.2001.20903 CrossRef

48.

Tokunaga K, Aslam N, Zdero R et al (2011) Effect of prior Salter or Chiari osteotomy on THA with developmental hip dysplasia. Clin Orthop Relat Res 469:237–243. doi:10.1007/s11999-010-1375-8 PubMedPubMedCentralCrossRef

Title: Triple osteotomy of the pelvis for Legg-Calve-Perthes disease: a mean fifteen year follow-up
Authors: Régis Pailhé
Etienne Cavaignac
Jérôme Murgier
Jean Philippe Cahuzac
Jerôme Sales de Gauzy
Franck Accadbled
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2687-9

At a glance: The STEP trials

Springer Medicine

Triple osteotomy of the pelvis for Legg-Calve-Perthes disease: a mean fifteen year follow-up

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach

Anterior cruciate ligament injury: post-traumatic bone marrow oedema correlates with long-term prognosis

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Intra-operative gaps affect outcome and postoperative kinematics in vivo following cruciate-retaining total knee arthroplasty

Complications and revisions after semi-constrained total elbow arthroplasty: a mono-centre analysis of one hundred cases

Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy