RESUMO
PURPOSE OF THE STUDY: The purpose of this study was to demonstrate the contribution of shelf acetobuloplasty for the treatment of Legg-Perthes-Calve disease. MATERIAL: Eighteen children with Legg-Perthes-Calve disease were operated on between 1992 and 2001. Mean age at diagnosis was 7 years 2 months, and mean age at surgery was 8 years 5 months (range 5-13 years). Mean motion was limited -25 degrees in abduction and internal rotation preoperatively. The radiological classification was: 2 Catterall II Herring B with signs of risk for the head, 8 IIB, 1 III C, 2 IV B, 3 IV C, and 2 at the sequelar stage. Mean excentration was 6.5 mm and mean overhang was 10.2 mm. METHOD: The indication for surgery was aggravation of the excentration or advanced revascularization. An iliac graft was embedded in the supralimbic and covered with a rectus femoris tendon which, left continuous, provided elastic support. A bermuda cast was used in 17 cases and immediate weight-bearing in 11. The patients were hospitalized 36 hours. RESULTS: Sixteen patients were reviewed at mean follow-up of 3 years 2 months (2 lost to follow-up). There were no complications. Clinically, the patients were pain free. Three patients had persistent limping 10 moderate limitation of motion, and three had severe stiffness. Radiologically, head covering was good in 15 cases, and joint congruency was achieved in 15 (11 of which were concentric). Shelf acetabuloplasty was considered useful in 12 cases, not useful in 1 after complete lysis of a poorly positioned graft, and of uncertain usefulness in 3 (including 2 cases treated at the sequalar stage). DISCUSSION: Femoral osteotomy for varisation and pelvic osteotomy for reorientation or enlargement of the acetabulum are effective but have certain drawbacks (limitation of abduction, leg length discrepancy, reintervention to remove material). The excellent integration of the shelf graft at mid-term is a good sign of correct head-acetabulum adaptation, with radiological and clinical results similar to other techniques. Joint stiffness and limping are observed in very severe forms where the prognosis depends on the stage of the disease. CONCLUSION: The patients in this series have not yet all reached maturity. Shelf plasty is a rapid, easily-performed, and safe means of enabling weight-bearing in Legg-Perthes-Calve hips undergoing excentration and beginning revascularization.
