Radiologic Changes after Shelf Acetabuloplasty on Legg-Calve-Perthes Disease

Sung Soo Kim; Chul Hong Kim; Myung Jin Lee; Man Seok Ko; Young Hoon Lim

doi:10.4055/jkoa.2012.47.3.185

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Kim, Kim, Lee, Ko, and Lim: Radiologic Changes after Shelf Acetabuloplasty on Legg-Calve-Perthes Disease

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(3): 185-190.

Published online: 26 June 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.3.185

Radiologic Changes after Shelf Acetabuloplasty on Legg-Calve-Perthes Disease

Sung Soo Kim, M.D., Chul Hong Kim, M.D., Myung Jin Lee, M.D., Man Seok Ko, M.D., Young Hoon Lim, M.D.

Department of Orthopedic Surgery, Dong-A University College of Medicine, Busan, Korea.

Correspondence to: Man Seok Ko, M.D. Department of Orthopedic Surgery, Dong-A University Medical Center, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan 602-715, Korea. TEL: +82-51-240-5166, FAX: +82-51-254-6757, kmanduk@naver.com

Received 17 August 2011 Revised 28 September 2011 Accepted 24 October 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the radiologic changes in the acetabulum after shelf acetabuloplasty in Legg-Calve-Perthes (LCP) disease.

Materials and Methods

From January 2003 to March 2006, 13 patients with unilateral LCP disease were treated by shelf acetabuloplasty. The mean follow-up period was 51 months. Pre-operative, post-operative, and annual follow-up radiographs were obtained to assess the changes in lateral subluxation ratio (LSR), acetabular head quotient (AHQ), acetabular depth index (ADI), acetabular height index (AHI), total depth index (TDI) and width of bone graft.

Results

The mean LSR decreased from 1.78±0.32 pre-operatively to 1.48±0.15 post-operatively, and remained 1.33±0.21 at last follow-up (p=0.011). The mean AHQ increased from 81.0±7.5% pre-operatively to 120.0±15.1% post-operatively, and remained 109.7±13.8% at final follow-up (p=0.001); the post-operative TDI that included the width of bone graft, decreased at follow-up. Furthermore, the mean ADI and AHI changed from 0.97±0.12, 1.13±0.07 pre-operatively to 1.04±0.02, 1.15±0.09 post-operatively; last follow-up results were 1.03±0.05 and 1.16±0.07, respectively. Between the 2 indices, post-operative ADI for 2 years was statistically significant (p<0.05). Also, the width of bone graft decreased from 24.4±3.6 mm post-operatively to 15.0±4.1 mm at final follow up (p<0.05).

Conclusion

The indices LSR and AHQ confirmed that the shelf acetabuloplasty could preserve the femoral head containment. The growth of the acetabulum after shelf acetabuloplasty was stimulated by increasing the depth of acetabulum in comparison with height for postoperative 2 years. Further follow-up is needed until skeletal maturity.

Keywords: acetabulum, Legg-Calve-Perthes disease, radiologic changes, shelf acetobuloplasty

Figures and Tables

Figure 1

Radiographs of an 8-year-old boy who has unilateral Legg-Calve-Perthes disease. The patient underwent shelf acetabuloplasty and epiphysiodesis at age of 8 years. (A) Pre-operative radiograph, (B) post-operative radiograph, (C) follow-up radiograph at 2 years after metal removal, (D) follow-up radiograph at 4 years after operation.

Figure 2

Schematic drawing of a hip affected by left Legg-Calve-Perthes disease. The measurement of the various radiological indices. In the affected hip, single quotation marks are added at each indice. LSR=A'/A, AHQ=(B'/C')/(B/C)×100, ADI=D'/D, AHI=H'/H, TDI=TD/D. A, medial joint space; B, the distance between the medial border of the femoral head and the lateral edge of the acetabulum; C, the distance between the medial border and the lateral rim of the femoral head; D, acetabular depth; H, acetabular height; TD, total acetabular depth; W, horizontal width of the graft; LSR, lateral subluxation ratio; AHQ, acetabular head quotient; TDI, total depth index.

Table 1

Lateral Subluxation Ratio and Acetabular Head Quotient

^*Lateral subluxation ratio; ^†acetabular head quotient; ^‡each statistical analysis compared the pre-operative value with the values of post-operation.

Table 2

Total Depth Index and Width of Bone Graft

^*Total acetabular depth index; ^†each statistical analysis compared the pre-operative value with the values of post-operation.

Table 3

Acetabular Depth Index and Acetabular Height Index

^*Acetabular depth index; ^†acetabular height index; ^‡each statistical analysis compared the pre-operative value with the values of postoperation.

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