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Low Early Failure Rates Using a Surgical Dislocation Approach in Healed Legg-Calvé-Perthes Disease

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

Abstract

Background

Hip deformity secondary to Legg-Calvé Perthes disease (LCPD) may result in femoroacetabular impingement (FAI) and ultimately osteoarthritis. Observations made with the surgical hip dislocation approach have improved our understanding of the pathologic mechanics of FAI. However, owing to concerns about complications related to the vascularity, the role of surgical hip dislocation in the treatment of healed LCPD remains controversial.

Questions/purposes

We present an algorithm to treat deformities associated with healed LCPD and asked (1) whether femoral head-neck osteochondroplasty and other procedures performed with the surgical hip dislocation approach provide short-term clinical improvement; and (2) is the complication rate low enough to be acceptable.

Methods

We retrospectively reviewed 29 patients (19 males, 10 females; mean age, 17 years; range, 9–35 years) with symptomatic LCPD between 2001 and 2009. All patients underwent a surgical hip dislocation approach and femoral head-neck osteochondroplasty and 26 patients had 37 additional procedures performed. Clinical improvement was assessed using the WOMAC index. The minimum followup was 12 months (mean, 3 years; range, 12–70 months).

Results

WOMAC scores improved at final followup (8 to 4 for pain, 21 to 13 for function, and 4 to 2 for the stiffness subscales). No patients had osteonecrosis, implant failure, deep infection, or nonunion. Three patients underwent THA at 1, 3, and 6 years after their index procedure.

Conclusions

Using the surgical hip dislocation approach as a tool to dynamically inspect the hip for causes of FAI, we were able to perform a variety of procedures to treat the complex deformities of healed LCPD. In the short term, we found improvement in WOMAC scores with a low complication rate.

Level of Evidence

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

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA

    Benjamin J. Shore MD, FRCSC, Eduardo N. Novais MD, Michael B. Millis MD & Young-Jo Kim MD, PhD

Authors
  1. Benjamin J. Shore MD, FRCSC
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  2. Eduardo N. Novais MD
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  3. Michael B. Millis MD
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  4. Young-Jo Kim MD, PhD
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Correspondence to Young-Jo Kim MD, PhD.

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Each author certifies that he or she has 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.

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Shore, B.J., Novais, E.N., Millis, M.B. et al. Low Early Failure Rates Using a Surgical Dislocation Approach in Healed Legg-Calvé-Perthes Disease. Clin Orthop Relat Res 470, 2441–2449 (2012). https://doi.org/10.1007/s11999-011-2187-1

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