title: Perthes' disease or late avascular necrosis after developmental dislocation of the hip? 10 children followed for 6-35 years.
abstract: We studied 10 patients treated because of late avascular necrosis (AVN) mimicking Legg-Calvé-Perthes' disease (LCPD) after developmental dislocation of the hip (DDH). DDH was recognized late at an average age of 5.4 months and in all children it was treated without surgery. In 4 children, the treatment was complicated by mild AVN of the femoral head, which had disappeared before 3 years of age. The first clinical signs of LCPD were noted at a mean age of 5.8 years. They all had Catterall's type III or IV of LCPD. The course was typical of LCPD. 8 children were operated on at mean age of 7.4 (5-12) years. In 7 of them, subtrochanteric derotation-varisation osteotomy of the femur with shortening combined mainly with Dega's pelvic osteotomy was done. The operative treatment resulted in a concentric position of the femoral head and good coverage of the acetabulum. Follow-ups were done at 10 (6-35) years. Shortened femoral neck and trochanteric overgrowth occurred in 4 operated hips. According to the Stulberg classification, 2 hips were classified as type I, 1 as I/II, 5 as II/I as II/III and 1 as IV. We conclude that LCPD mimicking late AVN can occur in hips treated because of developmental dislocation.
authors.affiliation: Department of Pediatric Orthopaedics, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Koczewski
authors.forename: M
authors.initials: M
authors.lastname: Napiontek
mesh_terms: D000367:Age Factors; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005269:Femur / Q000601:surgery; D005271:Femur Head Necrosis / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000145:classification / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008349:Manipulation, Orthopedic; D010027:Osteotomy; D010384:Pelvic Bones / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome