A New Innominate Osteotomy in Legg-Calve-Perthes' Disease

Ki Hyeoung Kim; Sang Gwon Cho; Taek Rim Yoon; Eun Kyoo Song; Jong Keun Seon; Gi Heon Park

doi:10.4055/jkoa.2007.42.1.8

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Kim, Cho, Yoon, Song, Seon, and Park: A New Innominate Osteotomy in Legg-Calve-Perthes' Disease

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(1): 8-15.

Published online: 28 February 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.1.8

A New Innominate Osteotomy in Legg-Calve-Perthes' Disease

Ki Hyeoung Kim, M.D., Sang Gwon Cho, M.D., Taek Rim Yoon, M.D., Eun Kyoo Song, M.D., Jong Keun Seon, M.D., Gi Heon Park, M.D.

Department of Orthopedics, Chonnam National University School of Medicine, Gwangju, Korea.

Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Korea.

Address reprint requests to Sang Gwon Cho, M.D. Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeonnam 519-809, Korea. Tel: +82.61-379-7676, Fax: +82.61-379-7681, drjo2023@naver.com

Abstract

Purpose

To evaluate the clinical and radiological results of a new innominate osteotomy in Legg-Calve-Perthes' disease (LCPD).

Materials and Methods

This study examined 25 hips that were treated with a new innominate osteotomy for LCPD. The treatment involved the anterior half of the ilium being osteomized in a direction of 45° to the coronal plane and 30° to 45° to the sagittal plane, and the posterior half of the ilium being cut using a Gigli saw according to the conventional method. The mean follow-up duration was 5.5 years. Stable interposition of the bone block was achieved using a single biodegradable screw in 8 hips, and without any fixation device in 17 hips.

Results

The clinical results according to the criteria of Robinson were good in 20 hips. Twelve hips was graded as good by the Mose method, according to the criteria of Stulberg, 8 hips were included in class I, 6 hips in class II, 8 hips in class III, and 3 hips in class IV. The mean center-edge angle improved from 19.4° to 30.2°.

Conclusion

The new innominate osteotomy is simpler and easier to perform than a routine Salter osteotomy, and satisfactory clinical results can be obtained without fixing the Kirschner wire.

Keywords: LCPD, New innominate osteotomy

Figures and Tables

Fig. 1

The center-edge angle (A) was measured from this line drawn from center of the ossific nucleus to the lateral ossified margin of the acetabulum and a line perpendicular to a third line joining the inferior margins of the sacroiliac joints. The template of mose (B) with concentric rings 2 mm apart are superimposed on the femoral head on the AP roentenogram, and the Mose method was used to assess the distance between the inner and outer best fitting ring superimposed on the femur head.

Fig. 2

(A) Diagram of the original Salter osteotomy. (B) This photographs show the site and direction of the original slater innominate osteotomy.

Fig. 3

(A) Diagram of our modification. (B) This photographs showing the site and direction of the modification. Maximum bony contact between the triangular fragment and host bone can be achieved.

Fig. 4

(A) Preoperative pelvis AP radiograph in a 6-year-old-girl with Legg-Calve-Perthes' disease of the Left hip (Caterall group IV). (B) This is the pelvis AP radiograph taken at 3 month after the new Salter innominate osteotomy. (C) A radiograph taken at the final examination when the patient was 11 years of age shows a Stulberg class II and a good Mose method.

Table 1

Patients' Demographic Data

Table 2

Clinical Results

Table 3

Radiological Results

Table 4

Preoperative and Post Operative Data on 25 Patients (25 Hips) Who Underwent an Innominate Osteotomy

R, restricted.

Table 5

Reports Comparing the Result of a Salter Innominate Osteotomy for Legg-Calve-Perthes' Disease

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