Muratli Hasan Hilmi, Can Murat, Yağmurlu Mehmet Firat, Aktekin Cem Nuri, Biçimoğlu Ali, Tabak Abdullah Yalçin
Ankara Numune Eğitim ve Araştirma Hastanesi, 5. Ortopedi ve Travmatoloji Kliniği.
Acta Orthop Traumatol Turc. 2003;37(2):138-43.
We evaluated the results of acetabular shelf procedures performed for the treatment of Legg-Calve-Perthes (LCP) disease.
The study included 14 patients (17 hips) with LCP disease, who were treated with acetabular shelf operation. The mean ages at the time of diagnosis, operations, and final examinations were 7 years (range 5 to 9 years), 8 years (range 6 to 10 years), and 12 years (range 10 to 16 years), respectively. The mean follow-up was five years (range 3 to 9 years). Before surgery, all patients had Catterall 3-4 hips, and at least two risk factors were identified. On pre- and postoperative anteroposterior and lateral radiograms, the Mose sphericity indices and CE angles were measured. In addition, the presence of hinge abduction was evaluated by dynamic arthrography preoperatively, and on direct radiograms and clinically during final examinations. The hips were graded according to a modified Stulberg classification on final direct radiograms. Clinical evaluation was made with the use of the Iowa hip scores.
The Mose measurements did not yield significant improvement on anteroposterior radiograms (p>0.05), whereas postoperative improvement was significant on lateral views (p<0.05). Improvement in CE angles was also statistically significant (p<0.001). According to the Stulberg classification, 10 hips (58.8%) (Stulberg 1-2) were successful, three hips (17.6%) (Stulberg 3) were discussible, and four hips (23.5%) (Stulberg 4-5) were failures. Of four failures, three patients were at the age of 9 years or above. The final Iowa hip scores ranged from 65 to 99 (mean 88.2). Hinge abduction disappeared postoperatively in seven hips (7/13, 53.8%).
Acetabular shelf operation following dynamic arthrography may be an alternative treatment option for hips with hinge abduction in LCP disease; however, it does not alter the natural course of the disease as the age increases.
