Skip to main content

Advertisement

SpringerLink
Log in

Labral Support Shelf Acetabuloplasty for Late Presenting Perthes Disease: Outcomes in Indian Patients

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Introduction

The treatment of late-presenting Perthes disease with extrusion is controversial and debatable. One of the options available is the labral shelf acetabuloplasty (LSA).

Aim

The aim of the study was to evaluate the results of LSA in late-presenting Perthes disease in terms of clinic-radiological outcome measures.

Materials and Methods

A retrospective analysis of prospectively collected data of patients with late presenting Perthes disease (Elizabethtown stage 2B onwards) treated by LSA by 2 experienced paediatric orthopaedic surgeons was performed. Data was collected of clinical parameters such as hip range of motion(ROM) and Harris Hip score and radiological parameters such as acetabular height, width and volume, shelf width, Centre Edge angle(CEA) and the lateral extrusion.

Results

Thirty-five patients (28 males and 7 females) treated between 2012 to 2019 were analyzed. Majority were in Elizabethtown stage 3A (23) followed by 2B and 3B (12 each). At a mean follow up of 36 months, the hip ROM and the Harris Hip Score (from 65 ± 3.5 to 81.33 ± 7.12) improved significantly and there was a statistically significant improvement in terms of all radiological parameters. Majority of the hips were in Stulberg grade 3 (20) followed by grade 1 and 2 (7 each) and Stulberg 4 (1). There were no major complications in any of the patients of the series.

Conclusion

Labral support shelf acetabuloplasty is a valuable surgery for late presenting Perthes disease and helps in maintenance of good coverage and allows restoration of range of motion over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Joseph, B., & Price, C. T. (2011). Principles of the containment treatment aimed at preventing femoral head deformation in perthes disease. Orthopedic Clinics of North America, 42(3), 317–327.

    Article  PubMed  Google Scholar 

  2. Stulberg, S. D., Cooperman, D. R., & Wallensten, R. (1981). The natural historyof Legg Calve Perthes disease. Journal of Bone and Joint Surgery. American Volume, 63, 1095.

    Article  CAS  PubMed  Google Scholar 

  3. Joseph, B., Varghese, G., Mulpuri, K., et al. (2003). Natural evaolution of Perthes disease: A study of 610 children under 12 years of age at disease onset. Journal of Pediatric Orthopedics, 23, 590–600.

    Article  PubMed  Google Scholar 

  4. Herring, J. A., Neustadt, J. B., Williams, J. J., et al. (1992). The lateral pillar classification of Leg-Calve-Perthes disease. Journal of Pediatric Orthopedics, 12, 143.

    Article  CAS  PubMed  Google Scholar 

  5. Staheli, L. T. (1981). Slotted acetabular augmentation. Journal of Pediatric Orthopedics, 1(3), 321–327.

    Article  CAS  PubMed  Google Scholar 

  6. Konishi, N., & Mieno, T. (1993). Determination of acetabular coverage of the femoral head with use of a single Anteroposterior radiograph. The Journal of Bone and Joint Surgery., 75, 1318–1333.

    Article  CAS  PubMed  Google Scholar 

  7. Humbert, L., Carlioz, H., Baudoin, A., et al. (2008). 3D evaluation of the acetabular coverage assessed by biplanar X-rays or single anteroposterior X-ray compared with CT-scan. Computer methods in Biomechanics and Biomedical engineering., 11(3), 257–262.

    Article  PubMed  Google Scholar 

  8. Sundt, H. (1949). Further investigation respecting malum coxae Calvé-Legg-Perthes’ disease with special regard to the prognosis and treatment. Acta Chir Scand., suppl 148, 1–101.

  9. Bellamy, N., Buchanan, W. W., Goldsmith, C. H., et al. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient- relevant outcomes following total hip or knee arthroplasty in osteoarthritis. Journal of Orthopedics Rheum, 1, 95.

    Google Scholar 

  10. Bowen, J. R., Guille, J. T., Jeong, C., Worananarat, P., et al. (2011). Labral support shelf arthroplasty for containment in early stages of Legg-Calve-Perthes disease. Journal of Pediatric Orthopedics, 31, S206–S211.

    Article  PubMed  Google Scholar 

  11. Wright, D., Perry, D., & Bruce, C. (2013). Shelf acetabuloplasty for perthes disease in patients older than eight years of age: An observational cohort study. JPO B, 22, 96–100.

    Google Scholar 

  12. Yoo, W. J., Moon, H. J., Cho, T., & Choi, I. H. (2012). Does Shelf acetabuloplasty influence acetabular growth and remodelling? Clinical Orthopaedics and Related Research, 470, 2411–2420.

    Article  PubMed  Google Scholar 

  13. Price, C. T., Thompson, G. H., & Wegner, D. R. (2011). Containment methods for treatment of Legg-Calve-Perthes disease. Orthopedic Clinics of North America, 42(3), 329–340.

    Article  PubMed  Google Scholar 

  14. Chang, J. H., Kuo, K. N., & Huang, S. C. (2011). Outcomes in advanced Legg-CalvePerthes disease treated with the Staheli procedure. Journal of Surgical Research, 168, 237–242.

    Article  PubMed  Google Scholar 

  15. Li, W. C., & Xu, R. J. (2016). Lateral shelf acetabuloplasty for severe Legg-Calve-Perthes disease in patients older than 8 years. A mean eleven-year folloe up. Medicine, 95(45), e5272.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Huang, M. J., & Huang, S. C. (1999). Surgical treatment of severe perthes disease: Comparison of triple osteotomy and shelf augmentation. Journal of the Formosan Medical Association, 98(3), 183–189.

    CAS  PubMed  Google Scholar 

  17. Bulut, M., Demerits, A., Ucar, B. Y., et al. (2014). Salter pelvic osteotomy in the treatment of Legg-Calve-Perthes disease: The medium-term results. Acta Orthopaedica Belgica, 80, 56–62.

    PubMed  Google Scholar 

  18. Salter, R. B. (1984). The present status of surgical treatment for Legg-Perthes disease. Journal of Bone and Joint Surgery. American Volume, 66, 961–966.

    Article  CAS  PubMed  Google Scholar 

  19. Sponseller, P. D., Desai, S. S., & Millis, M. B. (1988). Comparison of femoral and innominate osteotomies for the treatment of Legg-Calvé-Perthes disease. Journal of Bone and Joint Surgery. American Volume, 70(8), 1131–1139.

    Article  CAS  PubMed  Google Scholar 

  20. Noonan, K. J., Price, C. T., Kupiszewski, S. J., et al. (2001). Results of femoral varus osteotomy in children older than 9 years of age with Perthes disease. Journal of Pediatric Orthopedics, 21, 198–204.

    Article  CAS  PubMed  Google Scholar 

  21. Kruse, R. W., Guille, J. T., & Bowen, J. R. (1991). Shelf arthroplasty in patients who have Legg-Calve-Perthes disease. A study of long-term results. The Journal of Bone and Joint Surgery America, 73, 1338–1347.

    Article  CAS  Google Scholar 

  22. Daly, K., Bruce, C., & Catterall, A. (1999). Lateral shelf acetabuloplasty in Perthes’ disease. A review of the end of growth. The Journal of Bone Joint Surgery British, 81, 380–384.

    Article  CAS  Google Scholar 

  23. Van der Haven, I., Kooijman, M. A., Havinga, M. E., van der Geest, I. C., Jacobs, W., & Anderson, P. G. (2003). Teardrop-femoral head distance after shelf acetabuloplasty for Perthes’ disease. Acta Orthopaedica Belgica, 69(2), 157–161.

    PubMed  Google Scholar 

  24. Freeman, R. T., Wainwright, A. M., Theologis, T. N., & Benson, M. K. (2008). The outcome of patients with hinge abduction in severe Perthes disease treated by shelf acetabuloplasty. Journal of Pediatric Orthopedics, 28, 619–625.

    Article  PubMed  Google Scholar 

  25. Jacobs, R., Moens, P., & Fabry, G. (2004). Lateral shelf acetabuloplasty in the early stage of Legg-Calve-Perthes disease with special emphasis on the remaining growth of the acetabulum: A preliminary report. Journal of Pediatric Orthopedics. Part B, 13, 21–28.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India

    Udit Vinayak, Ashok Shyam, Parag Sancheti & Sandeep Patwardhan

  2. Department of Paediatric Orthopaedics, SRCC Children’s hospital, Haji Ali, Mumbai, India

    Chaitrali Gundawar

  3. Department of Paediatric Orthopaedics, Pinnacle OrthoCentre hospital, Thane, India

    Sandeep V. Vaidya

  4. Agashe’s Paediatric SuperSpeciality Clinic, MN Road, Kurla West, Mumbai, 400070, India

    Mandar V. Agashe

  5. Paediatric Orthopaedic Services, Department of Orthopaedic Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India

    Sandeep Patwardhan

Authors
  1. Udit Vinayak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chaitrali Gundawar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashok Shyam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Parag Sancheti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandeep V. Vaidya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mandar V. Agashe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sandeep Patwardhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mandar V. Agashe.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Standard Statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent

For this type of study informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vinayak, U., Gundawar, C., Shyam, A. et al. Labral Support Shelf Acetabuloplasty for Late Presenting Perthes Disease: Outcomes in Indian Patients. JOIO 57, 1785–1792 (2023). https://doi.org/10.1007/s43465-023-00978-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-023-00978-4

Keywords

Search

Navigation