Journal of Children's Orthopaedics

, Volume 6, Issue 6, pp 463–469 | Cite as

Valgus extension femoral osteotomy to treat “hinge abduction” in Perthes’ disease

  • Pasquale Farsetti
  • Matteo Benedetti-Valentini
  • Vito Potenza
  • Ernesto Ippolito
Original Clinical Article
  • 252 Downloads

Abstract

Purpose

“Hinge abduction” is a complication of Perthes’ disease caused by impingement of the extruded superolateral portion of the femoral head against the lateral lip of the acetabulum. Catterall first described femoral valgus extension osteotomy (VGEO) to treat this condition. We report the results of this operation in 16 cases of Perthes’ disease with “hinge abduction”.

Methods

Sixteen hips in 16 patients affected by Perthes’ disease and “hinge abduction” were operated on at a mean age of 10.1 years and followed up an average of 6.5 years later. Before surgery, the mean Iowa hip score was 44.4 points. Preoperative radiographs were taken with the affected hip in maximum adduction in order to calculate the amount of valgus correction. The osteotomy was performed between the greater and the lesser trochanter, and it was fixed with a hip plate.

Results

All the osteotomies healed uneventfully. At follow-up, no patient complained of pain and hip abduction ranged from 20° to 45°. Four out of the 16 patients had a moderate limp, and 12 had an improvement in gait pattern compared to preoperatively. At follow-up, the Iowa hip score totaled a mean of 83.6 points, with a statistically significant improvement in comparison to the preoperative evaluation. At follow-up, two hips were classified as Stulberg II–III, ten hips as Stulberg III, and four as Stulberg IV.

Conclusions

In our hands, VGEO was an effective procedure to treat “hinge abduction” in severe Perthes’ disease with satisfactory results. The main limitation of our study is its short follow-up.

Keywords

Perthes’ disease “Hinge abduction” Valgus extension femoral osteotomy Stulberg classification 

References

  1. 1.
    Grossbard GD (1981) Hip pain during adolescence after Perthes’ disease. J Bone Joint Surg Br 63B:572–574Google Scholar
  2. 2.
    Catterall A (1981) Legg–Calvé–Perthes syndrome. Clin Orthop Relat Res 158:41–52Google Scholar
  3. 3.
    Quain S, Catterall A (1986) Hinge abduction of the hip. Diagnosis and treatment. J Bone Joint Surg Br 68:61–64Google Scholar
  4. 4.
    Urlus M, Stoffelen D, Fabry G (1992) Hinge abduction in avascular necrosis of the hip: diagnosis and treatment. J Pediatr Orthop 1:67–71Google Scholar
  5. 5.
    Raney EM, Grogan DP, Hurley ME, Ogden MJ (2002) The role of proximal femoral valgus osteotomy in Legg–Calvé–Perthes disease. Orthopedics 25:513–517Google Scholar
  6. 6.
    Yoo WJ, Choi IH, Chung CY, Cho TJ, Kim HY (2004) Valgus femoral osteotomy for hinge abduction in Perthes’ disease. Decision-making and outcomes. J Bone Joint Surg Br 86:726–730CrossRefGoogle Scholar
  7. 7.
    Patil S, Sherlock D (2006) Valgus osteotomy for hinge abduction in avascular necrosis. J Pediatr Orthop B 15:262–266CrossRefGoogle Scholar
  8. 8.
    Myers GJ, Mathur K, O’Hara J (2008) Valgus osteotomy: a solution for late presentation of hinge abduction in Legg–Calvé–Perthes disease. J Pediatr Orthop 28:169–172CrossRefGoogle Scholar
  9. 9.
    Reinker KA (1996) Early diagnosis and treatment of hinge abduction in Legg–Perthes disease. J Pediatr Orthop 16:3–9CrossRefGoogle Scholar
  10. 10.
    Joseph B, Varghese G, Mulpuri K, Narasimha Rao KL, Nair NS (2003) Natural evolution of Perthes disease: a study of 610 children under 12 years of age at disease onset. J Pediatr Orthop 23:590–600CrossRefGoogle Scholar
  11. 11.
    Larson CB (1963) Rating scale for hip disabilities. Clin Orthop Relat Res 31:85–93Google Scholar
  12. 12.
    Tönnis D (1976) Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 119:39–47Google Scholar
  13. 13.
    Sharp IK (1961) Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br 43B:268–272Google Scholar
  14. 14.
    Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint. Acta Chir Scand 83(Suppl 58):7–38Google Scholar
  15. 15.
    Catterall A (1971) The natural history of Perthes’ disease. J Bone Joint Surg Br 53B:37–53Google Scholar
  16. 16.
    Stulberg SD, Cooperman DR, Wallensten R (1981) The natural history of Legg–Calvé–Perthes disease. J Bone Joint Surg Am 63:1095–1108Google Scholar
  17. 17.
    Kim HT, Oh MH, Lee JS (2011) MR imaging as a supplement to traditional decision-making in the treatment of LCP disease. J Pediatr Orthop 31:246–253CrossRefGoogle Scholar
  18. 18.
    Ippolito E, Tudisco C, Farsetti P (1985) Long-term prognosis of Legg–Calvé–Perthes disease developing during adolescence. J Pediatr Orthop 5:652–656CrossRefGoogle Scholar
  19. 19.
    Ippolito E, Tudisco C, Farsetti P (1987) The long-term prognosis of unilateral Perthes’ disease. J Bone Joint Surg Br 69:243–250Google Scholar
  20. 20.
    Farsetti P, Tudisco C, Caterini R, Potenza V, Ippolito E (1995) The Herring lateral pillar classification for prognosis in Perthes disease. Late results in 49 patients treated conservatively. J Bone Joint Surg Br 77:739–742Google Scholar
  21. 21.
    Bankes MJ, Catterall A, Hashemi-Nejad A (2000) Valgus extension osteotomy for “hinge abduction” in Perthes’ disease. Results at maturity and factors influencing the radiological outcome. J Bone Joint Surg Br 82:548–554CrossRefGoogle Scholar
  22. 22.
    Kruse RW, Guille JT, Bowen JR (1991) Shelf arthroplasty in patients who have Legg–Calvé–Perthes disease. A study of long-term results. J Bone Joint Surg Am 73:1338–1347Google Scholar
  23. 23.
    Daly K, Bruce C, Catterall A (1999) Lateral shelf acetabuloplasty in Perthes’ disease. A review of the end of growth. J Bone Joint Surg Br 81B:380–384CrossRefGoogle Scholar
  24. 24.
    Canale ST, D’Anca AF, Cotler JM, Snedden HE (1972) Innominate osteotomy in Legg–Calvé–Perthes disease. J Bone Joint Surg Am 54:25–40Google Scholar
  25. 25.
    Wenger DR, Pring ME, Hosalkar HS, Caltoum CB, Lalonde FD, Bastrom TP (2010) Advanced containment methods for Legg–Calvé–Perthes disease: results of triple pelvic osteotomy. J Pediatr Orthop 30:749–757CrossRefGoogle Scholar
  26. 26.
    Garceau GJ (1964) Surgical treatment of coxa plana. J Bone Joint Surg Br 46:779–780Google Scholar
  27. 27.
    McKay DW (1980) Cheilectomy of the hip. Orthop Clin North Am 11:141–160Google Scholar
  28. 28.
    Joseph B (1989) Morphological changes in the acetabulum in Perthes’ disease. J. Bone Joint Surg Br 71-B:756–763Google Scholar
  29. 29.
    Glard Y, Katchburian MV, Jacquemier M, Guillaume JM, Bollini G (2009) Genu valgum in Legg–Calvé–Perthes disease treated with femoral varus osteotomy. Clin Orthop Relat Res 467(6):1587–1590CrossRefGoogle Scholar

Copyright information

© EPOS 2012

Authors and Affiliations

  • Pasquale Farsetti
    • 1
  • Matteo Benedetti-Valentini
    • 1
  • Vito Potenza
    • 1
  • Ernesto Ippolito
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Rome “Tor Vergata”RomeItaly

Personalised recommendations