Valgus extension femoral osteotomy to treat “hinge abduction” in Perthes’ disease

Pasquale Farsetti,Matteo Benedetti-Valentini,Vito Potenza,Ernesto Ippolito

doi:10.1007/s11832-012-0453-8

Pasquale Farsetti, Matteo Benedetti-Valentini + Show 2 more

Open Access

https://doi.org/10.1007/s11832-012-0453-8

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Abstract

"Hinge abduction" is a complication of Perthes' disease caused by impingement of the extruded superolateral portion of the femoral head against the lateral lip of the acetabulum. Catterall first described femoral valgus extension osteotomy (VGEO) to treat this condition. We report the results of this operation in 16 cases of Perthes' disease with "hinge abduction". Sixteen hips in 16 patients affected by Perthes' disease and "hinge abduction" were operated on at a mean age of 10.1years and followed up an average of 6.5years later. Before surgery, the mean Iowa hip score was 44.4 points. Preoperative radiographs were taken with the affected hip in maximum adduction in order to calculate the amount of valgus correction. The osteotomy was performed between the greater and the lesser trochanter, and it was fixed with a hip plate. All the osteotomies healed uneventfully. At follow-up, no patient complained of pain and hip abduction ranged from 20° to 45°. Four out of the 16 patients had a moderate limp, and 12 had an improvement in gait pattern compared to preoperatively. At follow-up, the Iowa hip score totaled a mean of 83.6 points, with a statistically significant improvement in comparison to the preoperative evaluation. At follow-up, two hips were classified as Stulberg II-III, ten hips as Stulberg III, and four as Stulberg IV. In our hands, VGEO was an effective procedure to treat "hinge abduction" in severe Perthes' disease with satisfactory results. The main limitation of our study is its short follow-up.

Highlights

In severe cases of Legg–Calve–Perthes disease, deformity of the femoral head is likely to occur mainly during the fragmentation stage of the disease
We report the results of this operation in 16 cases of Perthes’ disease with ‘‘hinge abduction’’
Previous treatment consisted of containment with an Atlanta brace in seven patients, cheilectomy after protected weight-bearing with crutches in two patients, varus osteotomy followed by cheilectomy in one patient, and observation and physical therapy to maintain a good range of motion in six patients

Summary

Introduction

In severe cases of Legg–Calve–Perthes disease, deformity of the femoral head is likely to occur mainly during the fragmentation stage of the disease. The femoral head moves eccentrically instead of concentrically within the acetabulum, with widening of the inferomedial joint space and further reduction of the superolateral joint space. This alteration of the normal hip abduction movement was called ‘‘hinge abduction’’ about 30 years ago by Grossbard [1] and Catterall [2]. Valgus extension osteotomy (VGEO) was first described by Quain and Catterall [3] as a salvage surgical procedure to fix ‘‘hinge abduction’’ in Perthes’ disease.

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