Labral Support Shelf Arthroplasty for Containment in Early Stages of Legg-Calve-Perthes Disease

Abstract

Containment of the hip has become a popular strategy for treatment of severe Legg-Calve-Perthes disease; however, the best method remains unclear. This study describes a minimal-incision variation of the labral support shelf arthroplasty, which uses arthroscopic visualization and an allograft buttress on the shelf support. The outcome in a group of hips undergoing this minimal-incision variation is compared by the Stulberg classification with a group treated by the traditional anterolateral open operative approach. In addition, the outcomes of both groups of labral support shelf arthroplasties are compared then with other containment techniques used in our hospital consisting of Petric cast, varus femoral osteotomy, and innominate osteotomy of Salter. Forty-two patients who fulfilled the following criteria underwent a labral support shelf arthroplasty: (1) unilateral hip disease; (2) age equal to or older than 6 years at diagnosis; (3) Catterall group III or IV; and (4) Herring B or C disease. Twenty patients had a traditional open approach (group I) and 22 had an approach using a minimal-incision arthroscopic visualization and allograft buttress on the shelf support (group II). Outcomes by the Stulberg classification were then compared between these groups (I and II) and with 29 cases of Petri casting, 15 of varus femoral osteotomies, or 15 of innominate osteotomies of Salter. There is no statistical difference in Stulberg classification outcomes between group I and group II, which demonstrates that a minimally invasive technique is satisfactory and prevents substantial tissue dissection as is required in a standard anterior lateral approach to the hip, P>0.05. In addition, there is no statistical difference in Stulberg classification outcomes between the labral support shelf arthroplasties and common containment methods such as Petri casting, varus femoral osteotomies, or the innominate osteotomy of Salter, P>0.05. The labral support shelf arthroplasty by either the traditional method or the minimal-incision variation offers similar Waldenstrom class outcomes when compared with a Petric cast, a varus femoral osteotomy, or an innominate osteotomy of Salter. We believe the labral support shelf arthroplasty technique is simple to perform and does not induce a permanent deformity in the proximal femur or acetubulum.