Abstract
ObjectiveOur main objective is to assess the efficiency of the osteochondroplasty with relative neck lengthening in adults with healed Perthes clinically (through assessment of impingement-free hip ROM, functional scores) and radiographically.Patients and methodsThis was a prospective case series study included 30 hips of 30 patients who underwent osteochondroplasty and RNL due to symptomatic healed LCPD. This study included 16 males (53.3%) and 14 females (46.7%). The age of patients ranged from 19 to 40 years with mean age 26.4 years at the date of surgery (SD 6.4).ResultsMedian time of follow-up was 27.7 months after surgery (range 12–60 months). Two patients (6.6%) developed avascular necrosis (AVN) and needing total hip replacement; none of our patients developed nerve injury, detachment of the trochanteric fragment, and wound infection needing treatment. Preoperative Stulberg classes II and III improved more than preoperative Stulberg classes IV and V, although not statistically significant (P = 0.1104, n = 30). The mean HHS and WOMAC score values for each patient were higher in the Stulberg II and III groups compared to the Stulberg IV and V groupsConclusionHead and neck osteochondroplasty performed through the surgical dislocation approach, combined with RFNL, relieved pain and restored function in most of the patients with reasonable complications.Level of evidenceIV
Highlights
IntroductionThe hip with healed Legg-Calvé-Perthes disease (LCPD) usually have one or more of these abnormal pathoanatomies: dysplastic acetabulum; abnormal shape of femoral head (large, cone -shaped, flat, mushroom); short, thickened and varus femoral neck; and over-riding greater trochanter (functional coxa vara) [1]
The hip with healed Legg-Calvé-Perthes disease (LCPD) usually have one or more of these abnormal pathoanatomies: dysplastic acetabulum; abnormal shape of femoral head; short, thickened and varus femoral neck; and over-riding greater trochanter [1].The etiology of LCPD is still debated as the literature available shows major limitations in terms of great heterogeneity and a lack of high-profile studies
Head and neck osteochondroplasty performed through the surgical dislocation approach, combined with Relative femoral neck lengthening (RFNL), relieved pain and restored function in most of the patients with reasonable complications
Summary
The hip with healed Legg-Calvé-Perthes disease (LCPD) usually have one or more of these abnormal pathoanatomies: dysplastic acetabulum; abnormal shape of femoral head (large, cone -shaped, flat, mushroom); short, thickened and varus femoral neck; and over-riding greater trochanter (functional coxa vara) [1]. The etiology of LCPD is still debated as the literature available shows major limitations in terms of great heterogeneity and a lack of high-profile studies. The most used classification that determines the degree of deformity of LCPD hip is the Stulberg classification which correlates with the long-term outcome. Class V (aspherical incongruency) carries the worst prognosis and more risk of developing osteoarthritis (OA) at a younger age [1]
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