Outcomes of Combined Shelf Acetabuloplasty with Femoral Varus Osteotomy in Severe Legg-Calve-Perthes (LCP) Disease: Advanced Containment Method for Severe LCP Disease

BACKGROUND: Standard treatments may provide adequate containment in mild to moderate Legg-Calve-Perthes disease (LCPD), but they can be problematic in more severe cases. The purpose of this study was to report the results of combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD. METHODS: We reviewed 12 patients who had undergone combined shelf acetabuloplasty with femoral varus osteotomy. The indications for this type of operation were: (1) above 8 years of age at clinical onset; (2) massive femoral epiphysis involvement (Catterall group 4, lateral pillar C); (3) femoral head lateral subluxation on the anteroposterior radiograph; and (4) impending hinged abduction on preoperative magnetic resonance imaging or arthrography. The mean age was 9.3 years (range, 8 to 10.8 years). The patients were clinically evaluated with Iowa hip score and leg length discrepancy at the final follow-up. Radiographic outcome was assessed using the Stulberg classification to evaluate femoral head sphericity. The presence of osteoarthritis was evaluated by the Tonnis classification. Correlation analysis was conducted to analyze the preoperative factors that were strongly associated with patients' outcomes. RESULTS: The mean follow-up period was 10.1 years (range, 7.1 to 13.2 years). Functional grade was excellent in all patients at last follow-up (mean, 92; range, 82 to 99). The mean leg length discrepancy after skeletal maturity was 0.9 cm (range, 0 to 1.7 cm). There were no significant complications or need for additional surgery. Radiographically, 92% of patients reached satisfactory outcomes: Stulberg grade I, 0 cases; Stulberg grade II, 4 cases (34%); Stulberg III, 7 cases (58%), Stulberg IV, 1 case (8%); and Stulberg V, 0 cases. There was no osteoarthritis by Tonnis classification. CONCLUSIONS: The surgical outcomes for combined shelf acetabuloplasty with femoral varus osteotomy in severe LCPD patients over 8 years old are comparable with other advanced surgical methods. In the cases of severe disease that match our inclusion criteria, our containment method could be another treatment option.

Caracterización matemática de la enfermedad de Legg-Calvé-Perthes mediante geometría fractal / Caractérisation mathématique de la maladie de Legg-Calvé-Perthes par géométrie fractale / Mathematical characterization of Legg-Calve-Perthes disease through the fractal geometry

Introducción: la geometría fractal permite la medición objetiva de estructuras irregulares tales como las del cuerpo humano. Esta geometría se aplicó al desarrollo de una nueva metodología de caracterización de imágenes radiográficas frontales para la evaluación de enfermedad de Legg-Calve-Perthes. Objetivos: desarrollar una nueva metodología de caracterización matemática, objetiva y reproducible de la radiografía diagnóstica de Perthes, a partir de las imágenes radiográficas frontales obtenidas de la articulación de la cadera, mediante geometría fractal. Métodos: estudio exploratorio descriptivo en el que se evaluó la morfología de la cabeza del fémur mediante la dimensión fractal obtenida por el método de Box-Counting, aplicada a 20 placas radiográficas con enfermedad de Legg-Calve-Perthes, estableciendo una nueva medida morfométrica objetiva para esta enfermedad. Resultados: se obtuvieron nuevas medidas morfométricas objetivas y reproducibles de imágenes radiográficas frontales para la evaluación de enfermedad de Perthes a partir de dimensiones fractales. Conclusiones: la geometría fractal permite la caracterización matemática objetiva y reproducible de imágenes radiográficas frontales de la cadera para la evaluación de enfermedad de Perthes(AU)

Introduction: fractal geometry allows the objective measurement of irregular structures such as those of the human body. This geometry is applied to the development of a new methodology for characterization of front radiographic images for the evaluation of Legg-Calve-Perthes disease. Objectives: to develop a new methodology for the mathematical, objective and reproducible characterization of diagnostic radiography of Perthes disease from the front radiographic images of the hip joint by using the fractal geometry. Methods: descriptive and exploratory study that evaluated the morphology of the femur head through the fractal dimension estimated by the Box-Counting method, which was then applied to 20 radiographies of Legg-Calve-Perthes disease, thus establishing a new objective morphometric measure for this disease. Results: new objective reproducible morphometric measures of front radiographic images were reached to evaluate Perthes disease, taking fractual dimensions as a basis. Conclusions: fractal geometry allows the mathematical, objective and reproducible characterization of front radiographic images of the hip for the final evaluation of Perthes disease(AU)

Introduction: la géométrie fractale permet de mesurer objectivement les structures irrégulières telles que celles du corps humain. Cette géométrie a été appliquée au développement d'une nouvelle méthodologie de caractérisation des images radiographiques frontales pour l'évaluation de la maladie de Legg-Calve-Perthes. Objectifs: le but de cette étude est de développer une nouvelle méthodologie de caractérisation mathématique, objective et reproductible de la radiographie diagnostique de Perthes, à partir des images radiographiques frontales obtenues de l'articulation de la hanche par géométrie fractale. Méthodes: une étude descriptive préliminaire a été réalisée afin d'évaluer la morphologie de la tête fémorale par mesure de la dimension fractale (méthode de box-counting), appliquée à 20 plaques radiographiques de la maladie de Legg-Calve-Perthes, en établissant une nouvelle mesure morpho-métrique objective pour cette maladie. Résultats: on a obtenue de nouvelles mesures morpho-métriques objectives et reproductibles des images radiographiques frontales pour l'évaluation de la maladie de Legg-Calve-Perthes à partir des dimensions fractales. Conclusions: la géométrie fractale permet une caractérisation mathématique objective et reproductible des images radiographiques frontales de la hanche pour l'évaluation de cette maladie(AU)

[Prognosis and treatment of Legg-Calve-Perthes disease]

The authors report their long experience of Legg-Calve-Perthes disease in the Bretonneau's Hospital in Paris. The study of earlier cases has enabled them to estimate the risk factors for a possible evolution into arthritis. Analysis of recent cases have benefited from their experience of the bone scintigraphy. These concepts have affected the actual treatment the rules of which are stated