scholarly journals How to prevent graft resorption or breakage in shelf acetabuloplasty for Perthes disease with hinge abduction – A modified Staheli technique successful in 31 hips in midterm results

2021 ◽  
Vol 9 (3) ◽  
pp. 287-296
Author(s):  
Nariman Abol Oyoun ◽  
Mohamed Khaled ◽  
Hesham Mohamed Elbaseet ◽  
Abdel Khalek Hafez Ibrahim
Keyword(s):  
Joint Space ◽  
Perthes Disease ◽  
Acetabular Coverage ◽  
Center Edge ◽  
The Mean ◽  
Shelf Acetabuloplasty ◽  
Center Edge Angle ◽  
Space Ratio ◽  
Graft Resorption

BACKGROUND: Shelf acetabuloplasty covers the hip and allows remodeling in hips with Legg-Calv-Perthes disease and hinge abduction. Graft resorption or breakage is a bad complication that necessitate another surgical procedure. AIM: Our report evaluates a modified Staheli technique for graft resorption or breakage. MATERIALS AND METHODS: Case series study of 31 hips (29 patients) with mean age at operation was 8.1 (range 6-14 years). Duration of complaint ranged between one year and up to three years with the mean duration 1.52 0.76 years. The different parameters evaluating the hip as: Tnnis angle, Sharp angle, center-edge angle, and acetabular coverage percentage were measured. For unilateral cases only, medial joint space ratio and epiphyseal height ratio were evaluated. RESULTS: The mean postoperative follow-up was 47.8 9.8 months. All studied joints had Catterall type IV, Salter-Thompson classification type B. Seven joints were in Fragmentation stage whereas 24 joints were in re-ossification stage. Based on Lateral Pillar classification; only two joints were classified as B/C and 29 joints were classified as C. Final follow up internal rotation, abduction, center-edge angle, and acetabular coverage percentage were found to be significantly higher. In contrast, Tnnis angle and Sharps angle were significantly decreased. For unilateral cases, it was found that medial joint space ratio and epiphyseal height ratio were significantly decreased. None of the hips had resorbed or broken graft till final follow up. CONCLUSIONS: This modified Staheli technique prevent graft resorption or breakage. Shelf provides a good acetabular coverage for the deformed aspherical head with Legg-Calv-Perthes disease and hinge abduction to improve hip clinical and radiological outcome.

scholarly journals Shelf Acetabuloplasty in the Treatment of Severe Legg-Calvé-Perthes Disease: Good Outcomes at Midterm Follow-Up

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Andrzej Grzegorzewski ◽  
Marek Synder ◽  
Krysztof Kmieć ◽  
Karol Krajewski ◽  
Michał Polguj ◽  
...  
Keyword(s):  
Femoral Head ◽  
Type I ◽  
Leg Length ◽  
Midterm Results ◽  
Type Iv ◽  
Center Edge ◽  
The Mean ◽  
Shelf Acetabuloplasty ◽  
Center Edge Angle

The aim of the study was to retrospectively review results of operative treatment for coverage deficit of femoral head in children with severe epiphysis displacement in Legg-Calvé-Perthes (LCP) disease. The material included 23 shelf acetabuloplasty procedures for LCP disease. The average age at diagnosis was 8.1 years (range 4–12). Mean follow-up was 5.8 years (range from 2.2 to 11.2 years). Mean Reimer's index decreased statistically significantly from a mean of 32% before surgery to 10.0% at the last follow-up (P<0.00001). The mean Wiberg center-edge angle increased also statistically significantly from a mean of 17.3° before procedure to 32.3° at the last follow-up (P<0.00001). According to the Stulberg classification, type I was observed in 2, type II in 13, type III in 6, and type IV in 2 hips. There were no differences in the range of motion or leg length discrepancy in preoperative and postoperative standing. Partial, not significant, bone graft resorption was noted in 6 cases in the first 6–9 months after surgery. To conclude, shelf acetabuloplasty allows achieving good midterm results in the treatment of severe stages of LCP disease. The procedure improves coverage of femoral head and allows its remodelling.

Activity Level Maintenance at Midterm Follow-up Among Active Patients Undergoing Periacetabular Osteotomy

2019 ◽  
Vol 47 (14) ◽  
pp. 3455-3459
Author(s):  
Ugochi C. Okoroafor ◽  
Cecilia Pascual-Garrido ◽  
Maria T. Schwabe ◽  
Jeffrey J. Nepple ◽  
Perry L. Schoenecker ◽  
...  
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Activity Levels ◽  
Center Edge ◽  
Ucla Score ◽  
The Mean ◽  
Symptomatic Acetabular Dysplasia ◽  
Active Patients ◽  
Center Edge Angle

Background: For active patients undergoing periacetabular osteotomy (PAO), returning to and maintaining a high level of activity postoperatively is a priority. Purpose: To evaluate the maintenance of activity levels at midterm follow-up in active patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent PAO for symptomatic acetabular dysplasia between June 2006 and August 2013 were identified by a retrospective review of our prospective longitudinal institutional Hip Preservation Database. All patients with a preoperative University of California, Los Angeles (UCLA) score of ≥7 and a potential minimum 5 years of follow-up were included in the study. Functional outcome measures were the UCLA score, modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The maintenance of high activity levels was defined as a UCLA score of ≥7 at final follow-up. Radiographic parameters were measured. Statistical significance was defined as a P value <.05. Results: A total of 66 hips (58 patients) were included. The mean age was 25.3 years (range, 14-47 years), the mean body mass index was 23.9 kg/m2 (range, 19-32 kg/m2), and 72% were female. The mean follow-up was 6.8 years (range, 5-11 years). There were 67% of patients who maintained a UCLA score of ≥7. Patient-reported outcomes improved postoperatively from preoperatively for the mHHS (88 ± 14 vs 67 ± 17, respectively; P < .001) and WOMAC (89 ± 15 vs 73 ± 20, respectively; P < .001). The lateral center-edge angle, anterior center-edge angle, and acetabular inclination were significantly improved at final follow-up ( P < .001). Only 4 patients (7%) cited postoperative activity limitations as being caused by hip pain. There were no conversions to total hip arthroplasty. Conclusion: The majority (67%) of active patients returned to preoperative or higher activity levels after PAO at midterm follow-up.

scholarly journals Defining the Borderline Hip: High Variability in Acetabular Coverage and Femoral Deformity

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Maria Schwabe ◽  
Cecilia Pascual-Garrido ◽  
John Clohisy ◽  
Elizabeth Graesser Jeffrey Nepple
Keyword(s):  
Low Dose ◽  
Acetabular Dysplasia ◽  
Alpha Angle ◽  
Acetabular Coverage ◽  
Femoral Version ◽  
Center Edge ◽  
Text Figure ◽  
Femoral Deformity ◽  
The Mean ◽  
Center Edge Angle

Objectives: Borderline acetabular dysplasia is radiographically defined as a lateral center edge angle (LCEA) of 20-25 degrees. It is well accepted that some borderline hips have instability while others have primarily impingement. The optimal management of borderline dysplasia is challenging and particularly complex due to the anatomic variability that exists among patients but has not been well characterized. The purpose of this current study was to investigate the variability in hip deformity present on low-dose CT in a cohort of patients with symptomatic borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. Radiographic evaluation included LCEA, acetabular inclination, anterior center edge angle (ACEA), and alpha angles on AP, Dunn, and frog views. All patients underwent low-dose pelvic CT for preoperative planning. Femoral deformity was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Radial acetabular coverage was calculated according to standardized clockface positions [measured from 8:00 (posterior) to 4:00 (anterior)] and defined as normal, undercoverage, or overcoverage relative to 1 SD from the mean of normative values. Results: The mean LCEA was 22.1+1.4, while the mean acetabular inclination was 10.3+3.3. The mean ACEA in the group was 25.3+5.8 (range 10.1-43.9), with 16% having an ACEA < 20 and 50% having an ACEA < 25. The mean femoral version was 17.9° (range -4° to 59°). The mean maximal alpha angle was 57.2° (range 43° to 81°) with 61.4% greater than 55°. Lateral coverage (RAC at 12:00) was deficient in 74.1% of cases. Anterior coverage (RAC at 2:00) was highly variable with 17.1% undercoverage, 72.9% normal, and 10.0% overcoverage. Posterior coverage (RAC at 10:00) was also highly variable with 30.0% undercoverage, 62.9% normal, and 7.1% overcoverage. The three most common patterns of coverage were: isolated lateral undercoverage (31.4%), normal coverage (18.6%), and lateral and posterior undercoverage (17.1%). Conclusion: Patients with borderline acetabular dysplasia demonstrate highly variable three-dimensional deformities including anterior, lateral, and posterior acetabular coverage, femoral version, and alpha angle. Comprehensive deformity characterization in the population is important to guide diagnosis and treatment decisions. [Figure: see text][Figure: see text][Figure: see text]

scholarly journals DEFINING THE BORDERLINE HIP: HIGH VARIABILITY IN ACETABULAR COVERAGE AND FEMORAL DEFORMITY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0021
Author(s):  
Elizabeth Graesser ◽  
Maria Schwabe ◽  
Cecilia Pascual-Garrido ◽  
John C Clohisy ◽  
Jeffrey J Nepple
Keyword(s):  
Low Dose ◽  
Acetabular Dysplasia ◽  
Alpha Angle ◽  
Acetabular Coverage ◽  
Edge Angle ◽  
Femoral Version ◽  
Center Edge ◽  
Femoral Deformity ◽  
The Mean ◽  
Center Edge Angle

Introduction Borderline acetabular dysplasia is radiographically defined as a lateral center edge angle (LCEA) of 20-25 degrees. It is well accepted that some borderline hips have instability while others have primarily impingement. The optimal management of borderline dysplasia is challenging and particularly complex due to the anatomic variability that exists among patients but has not been well characterized. Purpose The purpose of this current study was to investigate the variability in hip deformity present on low-dose CT in a cohort of patients with symptomatic borderline acetabular dysplasia. Methods Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. Radiographic evaluation included LCEA, acetabular inclination, anterior center edge angle (ACEA), and alpha angles on AP, Dunn, and frog views. All patients underwent low-dose pelvic CT for preoperative planning. Femoral deformity was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Radial acetabular coverage was calculated according to standardized clock-face positions [measured from 8:00 (posterior) to 4:00 (anterior)] and defined as normal, under-coverage, or over-coverage relative to 1 SD from the mean of normative values. Results The mean LCEA was 22.1±1.4, while the mean acetabular inclination was 10.3±3.3. The mean ACEA in the group was 25.3±5.8 (range 10.1-43.9), with 16% having an ACEA ≤ 20 and 50% having an ACEA ≤ 25. The mean femoral version was 17.9° (range -4° to 59°). The mean maximal alpha angle was 57.2° (range 43° to 81°) with 61.4% greater than 55°. Lateral coverage (RAC at 12:00) was deficient in 74.1% of cases. Anterior coverage (RAC at 2:00) was highly variable with 17.1% under-coverage, 72.9% normal, and 10.0% over-coverage. Posterior coverage (RAC at 10:00) was also highly variable with 30.0% under-coverage, 62.9% normal, and 7.1% over-coverage. The three most common patterns of coverage were: isolated lateral under-coverage (31.4%), normal coverage (18.6%), and lateral and posterior under-coverage (17.1%). Discussion Patients with borderline acetabular dysplasia demonstrate highly variable three-dimensional deformities including anterior, lateral, and posterior acetabular coverage, femoral version, and alpha angle. Comprehensive deformity characterization in the population is important to guide diagnosis and treatment decisions.

Achieving Successful Outcomes in High-Level Athletes With Borderline Hip Dysplasia Undergoing Hip Arthroscopy With Capsular Plication and Labral Preservation: A Propensity-Matched Controlled Study

2021 ◽  
pp. 036354652110210
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
Kara B. Miecznikowski ◽  
Benjamin R. Saks ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Matched Control ◽  
Control Group ◽  
Acetabular Coverage ◽  
Center Edge ◽  
Labral Pathology ◽  
High Level ◽  
Lateral Center Edge Angle ◽  
Center Edge Angle

Background: Return to sports (RTS) rates and patient-reported outcomes (PROs) after hip arthroscopy in athletes with borderline dysplasia (BD) have not been established. Purpose: (1) To report minimum 2-year PROs and RTS rates in high-level athletes with BD who underwent hip arthroscopy for labral pathology in the setting of microinstability and (2) to compare clinical results with those of a matched control group of athletes with normal acetabular coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for surgery performed between January 2012 and July 2018. Patients were considered eligible if they received a primary hip arthroscopy in the setting of BD (lateral center-edge angle, 18°-25°) and competed in professional, collegiate, or high school sports. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Athletes with BD were matched to a control group of athletes with normal acetabular coverage (lateral center-edge angle, 25°-40°). Results: A total of 65 patients with BD were included in the study with a mean ± standard deviation follow-up of 47.5 ± 20.4 months. Athletes with BD showed significant improvement in all outcome measures recorded, demonstrated high RTS rates (80.7%), and achieved the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the Hip Outcome Score–Sport Specific Subscale at high rates (MCID, 90.8%; PASS, 75.4%). When compared with a propensity-matched control group with normal acetabular coverage, capsular plication was performed more commonly in the BD group (93.8% vs 82.7%; P = .037). PROs and RTS, PASS, and MCID rates were similar between the BD and control groups ( P > .05). Conclusion: High-level athletes with BD who undergo primary hip arthroscopy for labral pathology in the setting of microinstability may expect favorable PROs and RTS rates at minimum 2-year follow-up. These results were comparable with those of a control group of athletes with normal coverage.

The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes’ disease

2021 ◽  
Vol 103-B (12) ◽  
pp. 1815-1820
Author(s):  
Stefan Huhnstock ◽  
Ola Wiig ◽  
Else Merckoll ◽  
Svein Svenningsen ◽  
Terje Terjesen
Keyword(s):  
Femoral Head ◽  
Skeletal Maturity ◽  
Strong Predictor ◽  
Perthes Disease ◽  
Radiological Outcome ◽  
Long Term Follow Up ◽  
The Mean ◽  
Stulberg Classification

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

scholarly journals Postarthroscopy Imaging in Femoroacetabular Impingement: Persistent Pain May Be Due to an Insufficient Correction of Preoperative Abnormalities

Joints ◽  
2017 ◽  
Vol 05 (01) ◽  
pp. 021-026 ◽  
Author(s):  
Cosimo Tudisco ◽  
Salvatore Bisicchia ◽  
Sandro Tormenta ◽  
Amedeo Taglieri ◽  
Ezio Fanucci
Keyword(s):  
Case Series ◽  
Persistent Pain ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Mean Values ◽  
Center Edge ◽  
Patient Groups ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Purpose The purpose of this study was to evaluate the effect of correction of abnormal radiographic parameters on postoperative pain in a group of patients treated arthroscopically for femoracetabular impingement (FAI). Methods A retrospective study was performed on 23 patients affected by mixed-type FAI and treated arthroscopically. There were 11 males and 12 females with a mean age of 46.5 (range: 28–67) years. Center-edge (CE) and α angles were measured on preoperative and postoperative radiographic and magnetic resonance imaging (MRI) studies and were correlated with persistent pain at follow-up. Results The mean preoperative CE and α angles were 38.6 ± 5.2 and 67.3 ± 7.2 degrees, respectively. At follow-up, in the 17 pain-free patients, the mean pre- and postoperative CE angle were 38.1 ± 5.6 and 32.6 ± 4.8 degrees, respectively, whereas the mean pre- and postoperative α angles at MRI were 66.3 ± 7.9 and 47.9 ± 8.9 degrees, respectively. In six patients with persistent hip pain, the mean pre- and postoperative CE angles were 39.8 ± 3.6 and 35.8 ± 3.1 degrees, respectively, whereas the mean pre- and postoperative α angles were 70.0 ± 3.9 and 58.8 ± 2.6 degrees, respectively. Mean values of all the analyzed radiological parameters, except CE angle in patients with pain, improved significantly after surgery. On comparing patient groups, significantly lower postoperative α angles and lower CE angle were observed in patients without pain. Conclusion In case of persistent pain after arthroscopic treatment of FAI, a new set of imaging studies must be performed because pain may be related to an insufficient correction of preoperative radiographic abnormalities. Level of Evidence Level IV, retrospective case series.

Interpositional Arthroplasty With Extensor Digitorum Brevis Tendon in Freiberg Disease

2020 ◽  
Vol 41 (11) ◽  
pp. 1398-1403
Author(s):  
Nazan Çevik ◽  
Yavuz Akalın ◽  
Özgür Avci ◽  
Ali Çınar ◽  
Alpaslan Öztürk ◽  
...  
Keyword(s):  
Joint Space ◽  
Extensor Digitorum ◽  
Long Term Results ◽  
X Rays ◽  
Aofas Score ◽  
Interpositional Arthroplasty ◽  
Freiberg Disease ◽  
The Mean ◽  
Extensor Digitorum Brevis

Background: No consensus has been reached in the treatment of Frieberg disease. Our aim was to evaluate medium- to long-term results of patients with advanced Freiberg disease managed with extensor digitorum brevis tendon interpositional arthroplasty. Methods: There were 24 patients (19 females, 5 males) managed with interpositional arthroplasty for advanced Freiberg disease between 2003 and 2015. The mean follow-up was 133.8 (range, 60-198) months. According to Smillie classification, there were 4 grade 3, 13 grade 4, and 7 grade 5 patients. Patients were evaluated preoperatively and at the final follow-up with the American Orthopaedic Foot & Ankle Society (AOFAS) score and metatarsophalangeal joint range of motion and postoperatively with visual analog scale (VAS) and subjective satisfaction evaluation. Joint space was evaluated on x-rays. Results: Mean AOFAS score increased (53.9 to 80.3, P = .001). Eight patients had excellent, 14 had good, and 2 had fair scores. A significant increase was found in dorsiflexion (38.1° [24°-52°] vs 55.3° [34°-65°]; P = .001) and plantarflexion (19.0° [10°-28°] vs 28.6° [19°-39°]; P = .001). Narrowing of the joint space was not seen in any patient, but expansion was determined in all patients (0.39 [0.35-0.47] vs 0.44 [0.41-0.47] cm; P = .002). Of the patients, 9 were very satisfied, 12 were satisfied, 2 were moderately satisfied, and 1 was dissatisfied. The mean postoperative VAS pain score was 1.7 ± 0.9 (0-4). Conclusion: After a minimum 5-year follow-up, most patients with Freiberg disease managed with interpositional arthroplasty using the extensor digitorum brevis tendon had excellent to good functional results with a widening of the joint space. Level of Evidence: Level IV, retrospective case series.

scholarly journals Osteochondral allograft transplantation for large Hill-Sachs lesions: a retrospective case series with a minimum 2-year follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hongwu Zhuo ◽  
Yangkai Xu ◽  
Fugui Zhu ◽  
Ling Pan ◽  
Jian Li
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Satisfaction Rate ◽  
Allograft Transplantation ◽  
Constant Murley Score ◽  
Significant Difference ◽  
The Mean ◽  
Graft Resorption

Abstract Purpose To investigate the clinical outcomes after osteochondral allograft transplantation for large Hill-Sachs lesions. Methods Patients who underwent osteochondral allograft transplantation for large Hill-Sachs lesions were identified. Clinical assessment consisted of active range of motion (ROM), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score, Rowe score, and patient satisfaction rate. Radiographic assessment was performed with CT scan. Results Nineteen patients met the inclusion criteria. The mean age was 21.7 years. The mean preoperative size of the Hill-Sachs lesion was 35.70 ± 3.02%. The mean follow-up was 27.8 months. All grafts achieved union at an average of 3.47 months after surgery. At the final follow-up, graft resorption was observed in 43.1% of patients. The average size of residual humeral head articular arc loss was 12.31 ± 2.79%. Significant improvements (P < .001) were observed for the active ROM, ASES score, Constant-Murley score, and Rowe score. The overall satisfaction rate was 94.7%. No significant difference was found between the resorption group and the nonresorption group in postoperative clinical outcomes. Conclusion Osteochondral allograft transplantation is a useful treatment option for patients with large Hill-Sachs lesions. Although the incidence of graft resorption may be relatively high, the clinical outcomes at a minimum 2-year follow-up are favorable. Level of evidence Level IV, case series

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