Treatment of Legg-Calve-Perthes Disease Using Early Transphyseal Neck-Head Tunneling Combined with Late Hip Arthrodiastasis with the Ilizarov Apparatus. Comparative Study with Varus Intertrochanteric Osteotomy
Nuno Craveiro Lopes*
Orthopedic Department, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal
*Corresponding Author: Dr. Nuno Craveiro Lopes, Orthopedic Department, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal.
Received: February 11, 2022 Published: February 22, 2022
Abstract
Introduction: Late-onset Perthes disease usually carries a poor prognosis. In these cases, there may be increasing pain, a decreased of range of motion and hinge abduction which is a contraindication for surgical containment, as femoral varus osteotomy and pelvic osteotomy. In these cases, hip arthrodiastasis may be a valuable tool to solve such condition.
Methods: The authors compare the results of a group of 15 patients treated by arthrodiastasis with an Ilizarov frame (ADT) with a group of 13 patients treated by intertrochanteric osteotomy (OTM). The ADT group included twelve boys and three girls, was treated between 2000 and 2008, with a mean follow up of 8 years. The OTM group consisted of 11 boys and two girls, treated between 1979 and 1989, with a mean follow up of 6 years.
To proceed to ADT, we used a frame with two Ilizarov arches fixed in the supra-acetabular zones and in the proximal femur with 6 mm conical pins with hidroxyapatite in three-dimensional position, maintaining an articular distraction of 8-10mm for an average of three to five months. The osteotomy technique in the OTM group included a triple effect wedge with excision of a anterior-medial bone fragment, stabilized with an Synthes pediatric plate.
We collected data about the severity of injury, operative time, need for blood transfusion, time to onset of deambulation and complications. We assessed the radiological final result based on measurement of epiphyseal and cervical index, epiphyseal, acetabular and Wiberg angle and articular deformity by the Stulberg classification. For assessing the functional clinical outcome, we analyzed the leg length discrepancy and determined the "Harris Hip Score". The statistical analysis of the significance of differences was performed using the student test and Fisher exact test.
Results: The comparative study with data based evidence, showed that the ADT group:
- Presented results slightly better but not statistically significant, with regard to neck length.
- Presented significantly better sphericity of the head, joint congruence and less joint deformity, less residual sequelae, particularly with regard to the existence of varus deformity and leg length discrepancy.
- Had significantly better functional outcome as measured by the Harris Hip Score.
- Unlike the OTM group, had no complications or sequelae that could lead to new interventions.
- The surgical procedure was significantly faster, had no blood loss, patients began to walk with support significantly earlier and did not require a second surgery for hardware removal.
Keywords: Perthes; Osteotomy; Varization; Arthrodiastasis; Distraction; Legg-Calve-Perthes; osteonecrosis; avascular necrosis
Citation: Craveiro Lopes N. “Treatment of Legg-Calve-Perthes Disease Using Early Transphyseal Neck-Head Tunneling Combined with Late Hip Arthrodiastasis with the Ilizarov Apparatus. Comparative Study with Varus Intertrochanteric Osteotomy”. SVOA Paediatrics 1:1 (2022) Pages 24-34.