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Abstract
Purpose
To evaluate the interstitial and appositional growth of greater trochanter post-screw apophysiodesis in Legg-Calve-Perthes (LCP) disease.
Materials and Methods
A total of 17 patients, who were diagnosed with LCP and underwent greater trochanter screw apophysiodesis and metal removal between December 2003 and December 2012, and were followed-up for at least 4 years, were selected. Anterioposterior radiologic images were taken in each process of apophysiodesis, metal removal, and last follow-up. From such images, articulotrochanter tip distance (ATD), trochanter tip-screw distance (TSD), trochanter tip-trochanter lower margin distance (TLD), and screw-trochanter lower margin distance (SLD) were measured. Appositional growth and greater trochanter growth rates were compared using paired t-test, independent t-test, and correlation analysis.
Results
The average ATD of the affected and unaffected sides was 14.2 and 16.8 mm, respectively at apophysiodesis and 9.2 and 14.8 mm at the last follow-up, with a significantly greater decrease observed on the affected side the unaffected side (p=0.030). TLD of the affected side during the follow-up increased 11.0 mm, from an average of 30.8 to 41.8 mm, while the un-affected side increased 14.3 mm, from an average of 26.7 to 41.0 mm. The growth of greater trochanter after the operation in the affected side was 76.7% of that in unaffected side. The ratio of TLD of the affected side to the unaffected side was significantly reduced, from 1.15 to 1.02 (p=0.014) at the final follow-up. TSD was significantly increased from 4.5 to 14.4 mm at metal removal (p<0.001) and increased to 17.0 mm at the last follow-up. Moreover, the ratio of TSD to SLD was significantly increased from 0.20 to 0.74 at metal removal (p<0.001) and increased to 0.84 at the final follow-up.
Figures and Tables
Figure 1
Radiographs of a 7-year-old boy with unilateral Legg-Calve-Perthes disease. The patient received shelf operation and screw apophysiodesis. Preoperative radiograph (A), postoperative radiograph (B), postoperative 4 years radiograph (C), radiograph of metal removal (52 months after screw apophysiodesis) (D), and radiograph of the final follow-up (E).
Figure 2
Schematic drawing of the hip affected by left Legg-Calve-Perthes disease. The measurement of various radiological indices. Line ①: femoral head articular line (perpendicular to Line *), Line ②: greater trochanter tip line (perpendicular to Line *), Line ③: proximal screw neck line (perpendicular Line *), Line ④: greater trochanter lower margin line (perpendicular to Line *), Line *: anatomical axis of femur. ATD, articulo-trochanter tip distance; TSD, trochanter tip-screw distance; TLD, trochanter tip-trochanter lower margin distance; SLD, screw-trochanter lower margin distance.
Table 5
TSD between the Two Groups (One Performing Apophysiodesis above Age of 10 Years and the Other Performing Apophysiodesis below Age of 9 Years)
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