What Is the Evidence Supporting the Prevention of Osteoarthritis and Improved Femoral Coverage After Shelf Procedure for Legg-Calvé-Perthes Disease?
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The evidence supporting continued use of shelf acetabuloplasty in Legg-Calvé-Perthes disease (LCPD) is not well-defined, and there is controversy regarding the long-term benefits related to clinical and functional improvement.
Our goals were to determine whether shelf arthroplasty for LCPD (1) prevents the onset of early osteoarthritis; (2) improves pain, ROM, activity, and functional outcomes; (3) maintains or improves femoral head containment, sphericity, and congruency; (4) changes the acetabular index; and (5) is associated with a low rate of complications.
We performed a systematic review of the medical literature from 1966 to 2009 using the search terms Perthes, shelf procedure, and acetabuloplasty. We excluded reports using multiple/combined treatment methods and those not clearly stratifying outcomes. Thirteen studies met the criteria. There were no Level I studies, one Level II prognostic study, five Level III therapeutic studies, and seven Level IV studies. Mean followup ranged from 2.6 to 17.9 years.
Only one study reported progression to early osteoarthritis in one patient. We found no evidence for improvement in ROM and continued pain relief at long-term followup. Mean decrease in lateral subluxation ratio was 13% to 30%, demonstrating an improvement in femoral head containment. Mean acetabular cover percentage improved 16% to 38%, and mean acetabular and center-edge angles improved 4° to 14° and 8° to 33°, respectively. There were no reports of any major complications after the procedure.
While radiographic measurements indicate improved coverage of the femoral head after shelf acetabuloplasty for LCPD, available evidence does not document the procedure prevents early onset of osteoarthritis or improves long-term function.
- Atsumi T, Yoshihara S, Hiranuma Y. Revascularization of the artery of the ligamentum teres in Perthes disease. Clin Orthop Relat Res. 2001;386:210–217. CrossRef
- Bowen JR, Foster BK, Hartzell CR. Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 1984;185:97–108.
- Broder H. The late results in Legg-Perthes’ disease and factors influencing them: a study of one hundred and two cases. Bull Hosp Joint Dis. 1953;14:194–216.
- Bursal A, Erkula G. Lateral shelf acetabuloplasty in the treatment of Legg-Calvé-Perthes disease. J Pediatr Orthop B. 2004;13:150–152. CrossRef
- Calvé J. Sur une forme particuliere de coxalgie greffe sur des deformations caracteristiques de 1′extremite superieure de femur. Rev Chir. 1910;42:54.
- Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg Br. 1971;53:37–53.
- Catterall A. Legg-Calvé-Perthes syndrome. Clin Orthop Relat Res. 1981;158:41–52.
- Crutcher JP, Staheli LT. Combined osteotomy as a salvage procedure for severe Legg-Calvé-Perthes disease. J Pediatr Orthop. 1992;12:151–156. CrossRef
- Daly K, Bruce C, Catterall A. Lateral shelf acetabuloplasty in Perthes’ disease: a review of the end of growth. J Bone Joint Surg Br. 1999;81:380–384. CrossRef
- Domzalski ME, Glutting J, Bowen JR, Littleton AG. Lateral acetabular growth stimulation following a labral support procedure in Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 2006;88:1458–1466. CrossRef
- Domzalski ME, Inan M, Guille JT, Glutting J, Kumar SJ. The proximal femoral growth plate in Perthes disease. Clin Orthop Relat Res. 2007;458:150–158.
- Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88:372–379. CrossRef
- Freeman RT, Wainwright AM, Theologis TN, Benson MK. The outcome of patients with hinge abduction in severe Perthes disease treated by shelf acetabuloplasty. J Pediatr Orthop. 2008;28:619–625. CrossRef
- Ghanem I, Haddad E, Haidar R, Haddad-Zebouni S, Aoun N, Dagher F, Kharrat K. Lateral shelf acetabuloplasty in the treatment of Legg-Calvé-Perthes disease: improving mid-term outcome in severely deformed hips. J Child Orthop. 2009 November 13 [Epub ahead of print].
- Grzegorzewski A, Bowen JR, Guille JT, Glutting J. Treatment of the collapsed femoral head by containment in Legg-Calvé-Perthes disease. J Pediatr Orthop. 2003;23:15–19. CrossRef
- Herring JA. Legg-Calvé-Perthes disease. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics. 3rd ed. Philadelphia, PA: WB Saunders; 2001:655–704.
- Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1992;12:143–150. CrossRef
- Herring JA, Williams JJ, Neustadt JN, Early JS. Evolution of femoral head deformity during the healing phase of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1993;13:41–45. CrossRef
- Hoikka V, Poussa M, Yrjonen T, Osterman K. Intertrochanteric varus osteotomy for Perthes’ disease: radiographic changes after 2–16-year follow-up of 126 hips. Acta Orthop Scand. 1991;62:549–553. CrossRef
- Huang MJ, Huang SC. Surgical treatment of severe Perthes disease: comparison of triple osteotomy and shelf augmentation. J Formos Med Assoc. 1999;98:183–189.
- Ippolito E, Tudisco C, Farsetti P. The long-term prognosis of unilateral Perthes’ disease. J Bone Joint Surg Br. 1987;69:243–250.
- Jacobs BW. Early recognition of osteochondrosis of capital epiphysis of femur. J Am Med Assoc. 1960;172:527–531. CrossRef
- Jacobs R, Moens P, Fabry G. Lateral shelf acetabuloplasty in the early stage of Legg-Calvé-Perthes disease with special emphasis on the remaining growth of the acetabulum: a preliminary report. J Pediatr Orthop B. 2004;13:21–28. CrossRef
- Kallio P, Ryoppy S, Kunnamo I. Transient synovitis and Perthes’ disease: is there an aetiological connection? J Bone Joint Surg Br. 1986;68:808–811.
- King EW, Fisher RL, Gage JR, Gossling HR. Ambulation-abduction treatment in Legg-Calvé-Perthes disease (LCPD). Clin Orthop Relat Res. 1980;150:43–48.
- Kleinman RG, Bleck EE. Increased blood viscosity in patients with Legg-Perthes disease: a preliminary report. J Pediatr Orthop. 1981;1:131–136. CrossRef
- Kruse RW, Guille JT, Bowen JR. Shelf arthroplasty in patients who have Legg-Calvé-Perthes disease: a study of long-term results. J Bone Joint Surg Am. 1991;73:1338–1347.
- Kumar D, Bache CE, O’Hara JN. Interlocking triple pelvic osteotomy in severe Legg-Calvé-Perthes disease. J Pediatr Orthop. 2002;22:464–470. CrossRef
- Kuwajima SS, Crawford AH, Ishida A, Roy DR, Filho JL, Milani C. Comparison between Salter’s innominate osteotomy and augmented acetabuloplasty in the treatment of patients with severe Legg-Calvé-Perthes disease: analysis of 90 hips with special reference to roentgenographic sphericity and coverage of the femoral head. J Pediatr Orthop B. 2002;11:15–28. CrossRef
- Larson CB. Rating scale for hip disabilities. Clin Orthop Relat Res. 1963;31:85–93. CrossRef
- Lee MC, Eberson CP. Growth and development of the child’s hip. Orthop Clin North Am. 2006;37:119–132, v. CrossRef
- Legg AT. An obscure affection of the hip joint. Boston Med Surg. 1910;162:202. CrossRef
- Lloyd-Roberts GC, Catterall A, Salamon PB. A controlled study of the indications for and the results of femoral osteotomy in Perthes’ disease. J Bone Joint Surg Br. 1976;58:31–36.
- Love BR, Stevens PM, Williams PF. A long-term review of shelf arthroplasty. J Bone Joint Surg Br. 1980;62:321–325.
- McAndrew MP, Weinstein SL. A long-term follow-up of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1984;66:860–869.
- Mose K. Methods of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis. Clin Orthop Relat Res. 1980;150:103–109.
- Noonan KJ, Price CT, Kupiszewski SJ, Pyevich M. Results of femoral varus osteotomy in children older than 9 years of age with Perthes disease. J Pediatr Orthop. 2001;21:198–204. CrossRef
- O’Connor PA, Mulhall KJ, Kearns SR, Sheehan E, McCormack D. Triple pelvic osteotomy in Legg-Calvé-Perthes disease using a single anterolateral incision. J Pediatr Orthop B. 2003;12:387–389.
- Paterson DC, Leitch JM, Foster BK. Results of innominate osteotomy in the treatment of Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 1991;266:96–103.
- Perthes G. Uber Arthritis Deformans Juvenilis. Dtsch Z Chir. 1910;10:111. CrossRef
- Petrie JG, Bitenc I. The abduction weight-bearing treatment in Legg-Perthes’ disease. J Bone Joint Surg Br. 1971;53:54–62.
- Purvis JM, Dimon JH 3rd, Meehan PL, Lovell WW. Preliminary experience with the Scottish Rite Hospital abduction orthosis for Legg-Perthes disease. Clin Orthop Relat Res. 1980;150:49–53.
- Quain S, Catterall A. Hinge abduction of the hip: diagnosis and treatment. J Bone Joint Surg Br. 1986;68:61–64.
- Reinker KA. Early diagnosis and treatment of hinge abduction in Legg-Perthes disease. J Pediatr Orthop. 1996;16:3–9. CrossRef
- Richards BS, Coleman SS. Subluxation of the femoral head in coxa plana. J Bone Joint Surg Am. 1987;69:1312–1318.
- Salter RB. The present status of surgical treatment for Legg-Perthes disease. J Bone Joint Surg Am. 1984;66:961–966.
- Salter RB, Thompson GH. Legg-Calvé-Perthes disease: the prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am. 1984;66:479–489.
- Singh S, Hee HT, Low YP. Significance of the lateral epiphysis of the acetabulum to hip joint stability. J Pediatr Orthop. 2000;20:344–348. CrossRef
- Sponseller PD, Desai SS, Millis MB. Comparison of femoral and innominate osteotomies for the treatment of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1988;70:1131–1139.
- Staheli LT, Chew DE. Slotted acetabular augmentation in childhood and adolescence. J Pediatr Orthop. 1992;12:569–580.
- Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63:1095–1108.
- Sundt H. Further investigation respecting malum coxae Calvé-Legg-Perthes’ disease with special regard to the prognosis and treatment. Acta Chir Scand. 1949;suppl 148:1–101.
- Tachdjian MO. Tachdjian Pediatric Orthopedics. Philadelphia, PA: WB Saunders; 1990.
- Theron J. Angiography in Legg-Calvé-Perthes disease. Radiology. 1980;135:81–92.
- Thompson GH, Salter RB. Legg-Calvé-Perthes disease: current concepts and controversies. Orthop Clin North Am. 1987;18:617–635.
- van der Geest IC, Kooijman MA, Spruit M, Anderson PG, De Smet PM. Shelf acetabuloplasty for Perthes’ disease: 12-year follow-up. Acta Orthop Belg. 2001;67:126–131.
- van der Haven I, Kooijman MA, Havinga ME, van der Geest IC, Jacobs W, Anderson PG. Teardrop-femoral head distance after shelf acetabuloplasty for Perthes’ disease. Acta Orthop Belg. 2003;69:157–161.
- Vukasinovic Z, Slavkovic S, Milickovic S, Siqeca A. Combined Salter innominate osteotomy with femoral shortening versus other methods of treatment for Legg-Calvé-Perthes disease. J Pediatr Orthop B. 2000;9:28–33.
- Waldenstrom H. Der obere Tuberkulose collumnerd. Z Orthop Chir. 1909;24:487.
- Wiberg G. Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J Bone Joint Surg Am. 1953;35:65–80.
- Willett K, Hudson I, Catterall A. Lateral shelf acetabuloplasty: an operation for older children with Perthes’ disease. J Pediatr Orthop. 1992;12:563–568.
- Wynne-Davies R, Gormley J. The aetiology of Perthes’ disease: genetic, epidemiological and growth factors in 310 Edinburgh and Glasgow patients. J Bone Joint Surg Br. 1978;60:6–14.
- Yoo WJ, Choi IH, Cho TJ, Chung CY, Shin YW, Shin SJ. Shelf acetabuloplasty for children with Perthes’ disease and reducible subluxation of the hip: prognostic factors related to hip remodelling. J Bone Joint Surg Br. 2009;91:1383–1387. CrossRef
- Yrjonen T. Prognosis in Perthes’ disease after noncontainment treatment: 106 hips followed for 28–47 years. Acta Orthop Scand. 1992;63:523–526. CrossRef
- Zaza S, Wright-De Aguero LK, Briss PA, Truman BI, Hopkins DP, Hennessy MH, Sosin DM, Anderson L, Carande-Kulis VG, Teutsch SM, Pappaioanou M. Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med. 2000;18:44–74. CrossRef
- What Is the Evidence Supporting the Prevention of Osteoarthritis and Improved Femoral Coverage After Shelf Procedure for Legg-Calvé-Perthes Disease?
Clinical Orthopaedics and Related Research®
Volume 470, Issue 9 , pp 2421-2430
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- 1. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- 2. Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- 3. Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
- 4. Department of Orthopedic Surgery, Rady Children’s Hospital, UCSD San Diego, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA