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Triple Innominate Osteotomy for Legg-Calvé-Perthes Disease in Children: Does the Lateral Coverage Change With Time?

  • Symposium: Legg-Calvé-Perthes Disease: Where Do We Stand After 100 Years?
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calvé-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement.

Questions/purposes

We therefore asked (1) whether TIO contained the femoral head in Catterall Stages III and IV of LCPD; (2) whether the center-edge (CE) angle, acetabular roof arc angle (ARA), and Sharp’s angle changed during the growing years; and (3) what percentage of patients had radiographic evidence of pincer impingement beyond a minimum followup of 3 years.

Methods

We identified 19 children who had 20 TIOs performed for Catterall Stages III and IV LCPD. Two blinded observers assessed sequential radiographs. Each observer made two sets of readings more than 2 weeks apart. Femoral head extrusion index, CE angle of Wiberg, ARA, and Sharp’s angle were measured. Minimum followup was 3 years to document continued acetabular growth (mean, 3.8 years; range, 3–7 years).

Results

All patients exhibited femoral head containment at last followup. Eleven of 20 hips demonstrated no radiographic evidence of pincer morphology beyond a minimum followup of 3 years (mean, 3.8 years). Patients with CE angle corrected to 44° or less and an ARA of greater than −6° after TIO did not demonstrate a pincer morphology at last followup.

Conclusions

TIO resulted in femoral head containment in all cases. Lateral acetabular coverage changed during the growing years in all patients. Surgical correction beyond 44° of CE angle and −6° of ARA should be avoided to prevent pincer morphology later.

Level of Evidence

Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank J.D. Bomar for his help with illustrations and manuscript revision.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Rady Children’s Hospital, University of California-San Diego, 3030 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Harish Hosalkar MD & Dennis R. Wenger MD

  2. Department of Orthopaedic Surgery, Hospital Pequeno Principe, Curitiba, Brazil

    Ana Laura Munhoz da Cunha MD

  3. Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Keith Baldwin MD, MPH

  4. Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland

    Kai Ziebarth MD

Authors
  1. Harish Hosalkar MD
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  2. Ana Laura Munhoz da Cunha MD
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  3. Keith Baldwin MD, MPH
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  4. Kai Ziebarth MD
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  5. Dennis R. Wenger MD
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Corresponding author

Correspondence to Harish Hosalkar MD.

Additional information

Dr Hosalkar is a consultant for Synthes Trauma (West Chester, PA, USA). All other authors certify that they, and any members of their immediate family, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Rady Children’s Hospital, San Diego, CA, USA.

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Hosalkar, H., Munhoz da Cunha, A.L., Baldwin, K. et al. Triple Innominate Osteotomy for Legg-Calvé-Perthes Disease in Children: Does the Lateral Coverage Change With Time?. Clin Orthop Relat Res 470, 2402–2410 (2012). https://doi.org/10.1007/s11999-011-2189-z

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