Legg-Calve-Perthes Disease and Slipped Capital Femoral Epiphysis: Major Developmental Causes of Femoroacetabular Impingement

The Journal of the American Academy of Orthopaedic Surgeons (Impact Factor: 2.53). 06/2013; 21(suppl):S59-S63. DOI: 10.5435/JAAOS-21-07-S59


Problematic femoroacetabular impingement frequently is seen following Legg-Calvé-Perthes disease (LCPD) in young children and following slipped capital femoral epiphysis (SCFE) in older children and adolescents. Although symptoms may be mild in adolescents and young adults, chondral damage following LCPD and SCFE deformity is cumulative and irreversible, which has led to a recent emphasis on the consideration of early treatment. The surgical dislocation approach and improved MRI and three-dimensional CT have revealed common patterns of deformity and structural damage. The surgical dislocation approach is a superb diagnostic tool unmatched in assessing complex dynamic impingement patterns, and it allows direct treatment of deformity through recontouring of the head and neck and, in unhealed SCFE, epiphyseal realignment. The contemporary hip-preserving management of deformity following LCPD and SCFE is changing rapidly, necessitating careful evaluation of new treatment methods.

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    ABSTRACT: Background: Legg-Calve´-Perthes disease is a juvenile idiopathic osteonecrosis in which the blood supply of femoral head is not sufficient and the bone dies provisionally. The aim of this study is to evaluate outcome of Femoral osteotomy in children with LCPD in our University Hospital. Methods: In a descriptive analytic study, between 2008 and 2013, patients with the diagnosis of Legg-Calve'-Perthes confirmed with lateral pillar classification of B and B/C were entered and patients were encouraged to come to an outpatient clinic for follow-up. Descriptive analysis of the demographics was performed and relation between variables was tested using a two-sided Student's t test with statistical significance set at 0.05. Results: Mean age of patients was 9±1.3 years, with the range of 4 to 12 years old. 25 patients (86.2%) were male and 4 patients (13.4%) female. There was no positive family history in patients. 17 patients (58.6%) had history of trauma. Duration of symptom presentation was 7±6.3 months, with the range of 3 to 36 months. In 20 of patients (69%) left hip and in 12 (41.4%) right hip was involved. There was significant relation between femoral head asymmetry, trochanter enlargement (P=0.04), acetabolum changes (P<0.001), femoral neck shortening (P<0.001). There was no relation between age (P=0.28) and duration of disease (P=0.8) with femoral neck shortening. Conclusion: Intertrochanteric osteotomy led to improvement in pain, limping and increased range of motion. Subluxation before surgery is one of the criteria, which could influence further prognosis. Acetabulum changes and femoral neck shortening are two factors seriously affect hip ROM.
    12/2013; 1(2):90-3.
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