title: "Femoroacetabular impingement". Legg-Calve-Perthes disease: from childhood to adulthood.
abstract: OBJECTIVE
  The objective of this study was to investigate cases of femoroacetabular impingement (FAI) and analyze the risk factors for a painful hip at skeletal maturity after Perthes disease. We hypothesized that FAI occurs as a sequela of Perthes disease and that coxa plana and triple osteotomy of the pelvis (TOP) may be risk factors.
  
  
  METHODS
  Ninety-five hips were included from 1981 to 2011, 56 of which were operated on with TOP (53) or shelf acetabuloplasty (3). The results were evaluated at a mean 13years of follow-up (range, 2-23years) with Oxford score and hip radiograph analysis including the Stulberg grade, coxometry, and presence of a femoral bump. FAI was characterized by positional hip pain with preserved joint space and aspherical/nonspherical femoral head.
  
  
  RESULTS
  The Oxford score was optimal (12) in 79 hips (75%) and 20 or above in nine hips (9.5%). Seventeen hips were rated Stulberg I (18%), 36 Stulberg II (38%), 27 Stulberg III (28%), and 15 Stulberg IV or V (16%). The average acetabular angle was 10° (range, -4 to 25), VCE 41.5° (range, 18-80), and VCA 38.5° (range, 13-70). A femoral bump was noted in 31 hips (33%). Five cases of FAI were managed operatively with at least pain relief. Hip pain at the latest follow-up correlated with coxa plana (P=0.0003) and femoral bump (P=0.007). No significant correlation was found with a history of hip surgery or coxometry parameters.
  
  
  CONCLUSIONS
  Perthes hips bear risk for later FAI. Risk factors include coxa plana and femoral bump. In case of TOP, it is advocated to avoid excessive tilt, which may cause FAI.
  
  
  METHODS
  IV.
authors.affiliation: Service d'orthopédie, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France. Electronic address: faccadbled@wanadoo.fr.
authors.forename: F
authors.initials: F
authors.lastname: Accadbled
authors.affiliation: Service d'orthopédie, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
authors.forename: R
authors.initials: R
authors.lastname: Pailhé
authors.affiliation: Service de chirurgie orthopédique et pédiatrique, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: F
authors.initials: F
authors.lastname: Launay
authors.affiliation: Service de chirurgie et orthopédie de l'enfant, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Nectoux
authors.affiliation: Lyon Ortho Clinic, 29B, avenue des Sources, 69009 Lyon, France.
authors.forename: N
authors.initials: N
authors.lastname: Bonin
authors.affiliation: Service d'orthopédie-traumatologie pédiatrique, hôpital de Hautepierre, CHRU Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Gicquel
mesh_terms: D065526:Acetabuloplasty; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D057925:Femoracetabular Impingement / Q000145:classification / Q000209:etiology* / Q000601:surgery; D005500:Follow-Up Studies; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000150:complications* / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000009:adverse effects; D010384:Pelvic Bones / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Femoroacetabular impingement; Hip joint; Legg-Calve-Perthes disease; Triple osteotomy of the pelvis