scholarly journals Outcome of Varus Derotation Osteotomy for Containment of Femoral Head in Advanced Perthes Disease

2021 ◽  
Vol 10 (2) ◽  
pp. 79-85
Author(s):  
Mohammad Masud Rana ◽  
Nokul Kumar Datta ◽  
Mohammad Ishaq Bhuiyan ◽  
Md Asadullah Ripon ◽  
Abu Zihad Mohammad Salim
Keyword(s):  
Femoral Head ◽  
Clinical Information ◽  
Perthes Disease ◽  
X Rays ◽  
Continuous Variables ◽  
Varus Osteotomy ◽  
Neck Shaft Angle ◽  
Visual Analog Scales ◽  
Derotation Osteotomy ◽  
Group B

Background: Legg-Calve-Perthes (LCP) disease, or idiopathic avascular necrosis of the femoral head occurs during early childhood and is caused by impaired circulation in the femoral head. Varus derotation osteotomy (VDO) was described over half a century ago, and is now a popular method for the operative treatment of Perthes disease. Objective: To find out the clinical and radiological outcome of varus derotation osteotomy for containment of femoral head in advanced Perthes disease. Materials and Methods: This observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2015 to September 2017. Total 20 cases of advanced Perthes disease were enrolled. Pre- and post-operative period were evaluated by interview and clinical examination by using a semi-structured questionnaire. Demographic and clinical information were recorded. All patients had a pre- and post-operative x-rays. We used visual analog scales (VAS) for scoring pain; Wiberg’s central edge angle, epiphyseal extraction index, neck shaft angle and Larson (Iowa) hip score were used to assess the outcome of VDO. Comparison of continuous variables between the two groups was made with Student’s t-tests. Comparison of proportions between Herring groups B and C were made with chi-square tests. p<0.05 was considered as significant. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Sciences (SPSS 22.0). Results: In the present study, mean visual analog scale (VAS) score and epiphyseal extraction index (EEI) were significantly (p<0.001) lower in Herring Group B in comparison to that of Group C, but mean WCEA, NSA and HLS were significantly (p<0.001) higher in Herring Group B in comparison to that of Group C. Conclusion: Varus osteotomy gives good results in children aged 6–12 years who do not exhibit any femoral head deformity or flattening, especially those with good containment in abduction in advance Perthes disease. J Enam Med Col 2020; 10(2): 79-85

scholarly journals Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review

10.2196/27075 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e27075
Author(s):  
Arash Maleki ◽  
Seyyed Mohammad Qoreishy ◽  
Mohammad Nabi Bahrami
Keyword(s):  
Femoral Head ◽  
English Language ◽  
Surgical Techniques ◽  
Public Health Problem ◽  
Perthes Disease ◽  
Comprehensive Review ◽  
Varus Osteotomy ◽  
Manual Search ◽  
Surgical Methods ◽  
Innominate Osteotomy

Background Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

scholarly journals Cell technologies in the treatment of femoral head osteonecrosis

2019 ◽  
Vol 15 (4) ◽  
pp. 429-441
Author(s):  
A. E. Murzich ◽  
O. L. Eismont ◽  
J. I. Isaykina ◽  
D. V. Bukach ◽  
R. S. Sirotkin
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Mononuclear Cells ◽  
Bone Marrow Cells ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
X Rays ◽  
Femoral Head Osteonecrosis ◽  
Group A ◽  
Group B

The review of the literature data and our results of surgical treatment of femoral head osteonecrosis in adult patients with the minimally invasive technologies are presented in this article. Using clinical scales, X-rays, MRI, the hip joint condition of 46 patients who underwent “core” decompression in combination with bone plastic (group A, 31 patients) and bone marrow mononuclear cells (group B, 15 patients) were evaluated. The percentage of osteonecrosis progression during the observation period up to 3 years in group A was higher than in group B, where the bone marrow concentrate was used (38.7 and 26.7 %, respectively). The methods of treatment used for femoral head osteonecrosis are not traumatic, have no complications and allow delaying hip replacement. The use of autologous bone marrow cells, in addition to decompression of the necrosis focus, creates the prerequisites for a better outcome of bone regeneration of the necrotic area. 

scholarly journals Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review (Preprint)

2021 ◽  
Author(s):  
Arash Maleki ◽  
Seyyed Mohammad Qoreishy ◽  
Mohammad Nabi Bahrami
Keyword(s):  
Femoral Head ◽  
English Language ◽  
Surgical Techniques ◽  
Public Health Problem ◽  
Perthes Disease ◽  
Comprehensive Review ◽  
Varus Osteotomy ◽  
Manual Search ◽  
Surgical Methods ◽  
Innominate Osteotomy

BACKGROUND Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. OBJECTIVE The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. METHODS An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. RESULTS A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. CONCLUSIONS This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

scholarly journals Femoral neck shaft angle in relation to the location of femoral stress fracture in young military recruits: femoral head versus femoral neck stress fracture

2020 ◽  
Author(s):  
Dong-Kyu Kim ◽  
Tae Ho Kim
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Stress Fracture ◽  
Roc Analysis ◽  
Fracture Group ◽  
Neck Shaft Angle ◽  
Group A ◽  
Femoral Neck Stress Fracture ◽  
Shaft Angle ◽  
Group B

Abstract Objective To evaluate the influences of the femoral neck shaft angle (FNSA) on the location of the femoral stress fracture and to assess the potential differences in FNSA between fractured and normal femurs. Materials and methods Thirty-seven patients with femoral stress fractures who underwent both plain hip radiographs and MRI, from January 2016 to September 2019, were retrospectively included. Patients were classified as having either femoral head stress fracture (group A, n = 26) or femoral neck stress fracture (group B, n = 11). The FNSA was measured in anteroposterior (AP) hip radiograph. The Mann-Whitney U testing was used to compare the continuous values between the two groups. A receiver operating characteristic (ROC) analysis was used to evaluate the value of FNSA for predicting the risk of femoral stress fracture. Results The FNSA was significantly higher in group A (median 135.9°, range 129.5–138.6°) than group B (median 124.3°, range 119.5–129.0°) (p < 0.001), but there were no significant differences in other clinical factors. Furthermore, the FNSA was significantly higher at the fractured femurs (median 135.9°, range 129.9–138.6°) than contralateral normal femurs (median 127.9°, range 123.8–132.1°) in the patients with unilateral femoral head stress fracture (n = 22) (p < 0.001). The ROC analysis revealed that the area under curve (AUC), sensitivity, and specificity for predicting the risk of femoral head stress fracture were 0.807, 72.7%, and 68.2%, respectively, at a FNSA cutoff of 131.0°. Conclusion FNSA was associated with the location of the femoral stress fracture. In addition, FNSA could serve as a predictive factor for the risk of femoral head stress fractures.

The association between femoral neck shaft angle and degenerative disease of the hip in a cadaveric model

2021 ◽  
pp. 112070002110130
Author(s):  
Leigh-Anne Tu ◽  
Douglas S Weinberg ◽  
Raymond W Liu
Keyword(s):  
Femoral Head ◽  
Femoral Neck ◽  
Hip Osteoarthritis ◽  
Volume Ratio ◽  
Femoral Head Coverage ◽  
Neck Shaft Angle ◽  
Hip Arthritis ◽  
Femoral Version ◽  
Shaft Angle ◽  
The Impact

Background: While the influences of acetabular dysplasia and overcoverage on hip arthritis have been studied, the impact of femoral neck-shaft angle on hip arthritis is much more poorly understood. The purpose of this study is to determine if a relationship exists between neck shaft angle and the development of osteoarthritis, a better understanding of which would be useful to surgeons planning osteotomies about the hip. Methods: 533 cadaveric femora and acetabulae (1066 total) from the Hamann-Todd Osteological Collection (Cleveland, OH) were acquired. We measured true neck shaft angle using an AP photograph with the femoral neck parallel to the table. Femoral head volume to acetabular volume ratio, representing femoral head coverage, as well as femoral version were utilised. Correlation between neck shaft angle, femoral version, femoral head coverage and osteoarthritis were evaluated with multiple regression analysis. Results: The mean age and standard deviation was 56 ± 10 years. There were 64 females (12%) and 469 males. There were 380 Caucasians (71%) and 153 African-Americans. Mean femoral version was 11° ± 12° and mean true neck shaft angle was 127.7° ± 5.9° There was a strong correlation between age and arthritis (standardised beta 0.488, p < 0.001). There was a significant correlation between increasing true neck shaft angle and decreasing hip arthritis (standardised beta -0.024, p = 0.038). In the femoral head overcoverage subset, increasing true neck shaft angle was still significantly associated with decreasing hip arthritis (standardised beta −0.088, p = 0.018), although this relationship was not significant with femoral head undercoverage subset. Conclusions: With sufficient acetabular coverage, a relative increase in femoral neck shaft angle within the physiologic range is associated with decreased hip osteoarthritis. Clinical relevance: An understanding of the relationship between femoral neck shaft angle and hip osteoarthritis could be useful for surgeons planning pelvic or proximal femur osteotomies in children.

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.

Legg-Calvé-Perthes Disease

1986 ◽  
Vol 7 (10) ◽  
pp. 299-304
Author(s):  
William P. Bunnell
Keyword(s):  
Birth Weight ◽  
Femoral Head ◽  
Vascular Supply ◽  
Skeletal Age ◽  
Perthes Disease ◽  
Unknown Etiology ◽  
Necrotic Bone

Perthes disease is a condition of unknown etiology in which the vascular supply of the developing femoral head is temporarily interrupted, causing necrosis and collapse of the bony femoral head, followed by spontaneous revascularization and healing of the necrotic bone. It was independently described by four different authors (Legg, Calvé, Perthes, and Waldenstrom) in 1909 and 1910. They identified the condition as an affliction of the hip distinct from trauma and infection. The term "coxa plana" was applied to the characteristic flattening of the femoral head seen in Perthes disease. It was not until 10 years later that the actual pathology of avascular necrotic bone was described. EPIDEMIOLOGY The condition has its onset in children ranging in age from 2 to 12 years, with the majority of patients presenting between the ages of 4 and 8 years. Boys are affected four times more frequently than girls, and the condition is bilateral in approximately 15% of affected children. Certain constitutional factors are frequently found in children with Perthes disease. Skeletal age is delayed in nearly 90% of children affected with it. Affected boys have been found to be an average of 1 in shorter and affected girls 3 in shorter in height than their unaffected peers. Birth weight of affected children is frequently lower than average.

scholarly journals The Cliff Sign: A New Radiographic Sign of Hip Instability

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880717 ◽  
Author(s):  
Jonathan D. Packer ◽  
James B. Cowan ◽  
Brian J. Rebolledo ◽  
Kotaro R. Shibata ◽  
Geoffrey M. Riley ◽  
...  
Keyword(s):  
Femoral Head ◽  
Preoperative Diagnosis ◽  
Interobserver Reliability ◽  
Radiographic Finding ◽  
Synovial Chondromatosis ◽  
Pigmented Villonodular Synovitis ◽  
Angle Measurement ◽  
Continuous Variables ◽  
Level Of Evidence ◽  
Hip Reduction

Background: The preoperative diagnosis of hip microinstability is challenging. Although physical examination maneuvers and magnetic resonance imaging findings associated with microinstability have been described, there are limited reports of radiographic features. In patients with microinstability, we observed a high incidence of a steep drop-off on the lateral edge of the femoral head, which we have named the “cliff sign.” Purpose: (1) To determine the relationship of the cliff sign and associated measurements with intraoperative microinstability and (2) to determine the interobserver reliability of these measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 115 consecutive patients who underwent hip arthroscopy were identified. Patients with prior hip surgery, Legg-Calve-Perthes disease, fractures, pigmented villonodular synovitis, or synovial chondromatosis were excluded, resulting in the inclusion of 96 patients in the study. A perfect circle around the femoral head was created on anteroposterior pelvis radiographs. If the lateral femoral head did not completely fill the perfect circle, it was considered a positive cliff sign. Five additional measurements relating to the cliff sign were calculated. The diagnosis of microinstability was made intraoperatively by the (1) amount of traction required to distract the hip, (2) lack of hip reduction after initial traction release following joint venting, or (3) intraoperative findings consistent with hip microinstability. Continuous variables were analyzed through use of unpaired t tests and discrete variables with Fisher exact tests. Interobserver reliability (n = 3) was determined for each measurement. Results: Overall, 89% (39/44) of patients with microinstability had a cliff sign, compared with 27% of patients (14/52) without instability ( P < .0001). Conversely, 74% of patients with a cliff sign had microinstability, while only 12% of patients without a cliff sign had instability ( P < .0001). In women younger than 32 years with a cliff sign, 100% (20/20) were diagnosed with instability. No differences were found in any of the 5 additional measurements. Excellent interobserver reliability was found for the presence of a cliff sign and the cliff angle measurement. Conclusion: We have identified a radiographic finding, the cliff sign, that is associated with the intraoperative diagnosis of hip microinstability and has excellent interobserver reliability. Results showed that 100% of young women with a cliff sign had intraoperative microinstability. The cliff sign may be useful in the preoperative diagnosis of hip microinstability.

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