Management of residual hip deformities secondary to Legg–Calve–Perthes disease in adults

Abstract

Background The objective of this study is to systematically review the results of different studies related to the management of hip deformities secondary to Perthes’ disease in adults. Patients and methods Thirteen studies matching the inclusion and exclusion criteria, totaling 316 adults including 326 hips that underwent 119 surgical hip dislocation (SHD), 49 periacetabular osteotomy, 111 SHD with periacetabular osteotomy, 16 intertrochanteric osteotomy with acetabular roof plasty, and 31 adductor tenotomy with cheilectomy of the femoral head. Their age was in the range from 19 to 42 years with clinical follow-up range (16–135 months). The degree of pain, function, range of movements, and deformities were evaluated. Results The SHD approach has a 360° view allowing full dynamic evaluation of the hip joint, identification, and correction of the most common residual deformations, leading to functional improvement and pain relief with low complication rates. Harris hip score was a common clinical parameter in a lot of studies and showed improvement from the average range (60–68.5) before surgery to 72–95 after it. In all, 188 hips were reported to have reduction in pain at last follow-up, but adequate clinical follow-up were not available for 112 hips. However, 26 patients were reported as a failure (defined as total hip arthroplasty or persistent or increased pain). Onset osteoarthritis advancement cannot be prevented in hips. Conclusion SHD provides the opportunity to achieve any kind of simultaneous femoral and acetabular osteotomies leading to functional improvement and pain relief with low complication rates.