Article

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

ABSTRACT

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.
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    ABSTRACT: Several risk factors may cause femoroacetabular impingement (FAI). Knowledge of causation would identify patients for early intervention, prior to the development of painful intra-articular damage. PubMed, MEDLINE, EMBASE, and related article reference lists were screened for relevant studies published between January 2000 and December 2013. Inclusion criteria were (1) etiology of FAI, (2) original FAI clinical data, and (3) English language. Case reports of fewer than 3 patients were excluded. Systematic review. Level 4. In all, 754 studies were screened, with 18 meeting the eligibility criteria. There were 13 comparative observational studies and 5 case series. The studies pertained to intrinsic patient factors (n = 2), activity/developmental factors (n = 8), hip disease (n = 5), postsurgical changes (n = 2), and malunion after hip fracture (n = 1). A combination of intrinsic patient and developmental factors, activities involving repetitive hip motion, pediatric hip disease, and hip-related surgical procedures may contribute to the development of FAI.
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    ABSTRACT: Slipped capital femoral epiphysis (SCFE) is the most common pediatric hip disorder and is a potential precursor to early hip arthritis in severely affect patients. The offending lesion is the prominent anterosuperior femoral neck metaphysis that displaces anteriorly during epiphyseal slippage. Though patients may be able to bear weight after healing the acute SCFE, eventual hip pain, decreased range of motion, and intra-articular derangement may develop. Arthroscopic treatment of proximal femoral deformity resulting from SCFE has been described as a joint preservation technique and has been demonstrated to be a safe and effective alternative to open surgical dislocation and osteoplasty.
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