Shelf acetabuloplasty for containment in the early stages of Legg-Calve-Perthes disease.
BACKGROUND
To evaluate the effectiveness of shelf acetabuloplasty in the containment of extruded hips without hinge abduction in early stages of Legg-Calve-Perthes disease, we present a retrospective series of 44 patients (45 hips) treated between August 1999 and February 2010, which included 34 boys and 10 girls with a mean age at diagnosis of 7.4 years (range, 3.9 to 15.3).


METHODS
All patients presented with sclerosis or early fragmentation stages. The average time from diagnosis to surgery was 2.1 months (range, 0 to 8.2) and the mean time to heal was 40.4 months (range, 20 to 82.2). The Reimer migration and the deformity indices were measured on initial, preoperative, postoperative, and healed x-rays. The average deformity index at 3 of those 4 timepoints was significantly related to their final Stulberg classification. CE angles increased and Sharp angles decreased significantly as a result of treatment.


RESULTS
At the healed stage and consistent with other published series, 84.4% of patients were Stulberg III or less, denying any pain, and with full range of movement, whereas 15.6% were classified as Stulberg IV.


CONCLUSIONS
We defend that shelf acetabuloplasty should be performed early in the disease and, uniquely, we propose that the indication for treatment should be guided by the deformity and the Reimer migration indices.


METHODS



METHODS
IV.
Department of Child Health, University Hospital Southampton, Southampton, Hampshire, UK.
Belen
B
Carsi
Julia
J
Judd
Nicholas M P
NM
Clarke
D065526:Acetabuloplasty / Q000009:adverse effects / Q000379:methods; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008297:Male; D062072:Patient Acuity; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D006113:United Kingdom