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Impingement-free hip range of motion after osteochondroplasty and relative neck lengthening in adults with healed Perthes disease.

ABSTRACT: OBJECTIVE:Our main objective is to assess the efficiency of the osteochondroplasty with relative neck lengthening in adults with healed Perthes clinically (through assessment of impingement-free hip ROM, functional scores) and radiographically. PATIENTS AND METHODS:This was a prospective case series study included 30 hips of 30 patients who underwent osteochondroplasty and RNL due to symptomatic healed LCPD. This study included 16 males (53.3%) and 14 females (46.7%). The age of patients ranged from 19 to 40?years with mean age 26.4?years at the date of surgery (SD 6.4). RESULTS:Median time of follow-up was 27.7?months after surgery (range 12-60?months). Two patients (6.6%) developed avascular necrosis (AVN) and needing total hip replacement; none of our patients developed nerve injury, detachment of the trochanteric fragment, and wound infection needing treatment. Preoperative Stulberg classes II and III improved more than preoperative Stulberg classes IV and V, although not statistically significant (P = 0.1104, n = 30). The mean HHS and WOMAC score values for each patient were higher in the Stulberg II and III groups compared to the Stulberg IV and V groups CONCLUSION: Head and neck osteochondroplasty performed through the surgical dislocation approach, combined with RFNL, relieved pain and restored function in most of the patients with reasonable complications. LEVEL OF EVIDENCE:IV.

SUBMITTER: Elmarghany M

PROVIDER: S-EPMC7448520 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Impingement-free hip range of motion after osteochondroplasty and relative neck lengthening in adults with healed Perthes disease.

Elmarghany Mohammed M Abd El-Ghaffar Tarek M TM Elgeushy Ahmed A Hasanin Yehia Y Elzahed Ehab E Abulsoud Mohamed I MI Moawad Mohamed M

Journal of orthopaedic surgery and research 20200826 1

<h4>Objective</h4>Our main objective is to assess the efficiency of the osteochondroplasty with relative neck lengthening in adults with healed Perthes clinically (through assessment of impingement-free hip ROM, functional scores) and radiographically.<h4>Patients and methods</h4>This was a prospective case series study included 30 hips of 30 patients who underwent osteochondroplasty and RNL due to symptomatic healed LCPD. This study included 16 males (53.3%) and 14 females (46.7%). The age of p ...[more]

PMID: 32847600

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Project description:Background: Typical sequelae of Perthes disease and Perthes-like deformities comprise a short femoral neck, aspherical femoral head, and greater trochanteric overgrowth. Morscher’s osteotomy aims at restoring the normal extra-articular anatomy, but incapable of restoring a normal head-neck contour with residual impingement. Femoral neck lengthening osteotomy combined with osteochondroplasty through surgical hip dislocation approach was not previously described in the literature. We hypothesized that this technique is capable of near-normal restoration of the proximal femoral anatomy, increasing limb length, restoring abductor power, and simultaneous management of intra-articular chondro-labral disease. Methods: A prospective series of 21 consecutive patients with sequelae of Perthes disease and Perthes-like deformity (Stulberg II and III) were treated by Morscher’s osteotomy through surgical hip dislocation approach. The mean age was 14.9 years (9–30 years) and the mean follow-up was 4.5 years (2–8 years). Results: The mean Harris hip score improved significantly from 66.5 to 89.5 points (p < 0.001), and the mean limb length discrepancy improved from 2.5 to 0.6 cm (p < 0.001). The mean alpha angle improved from 81.8° to 49.5°, the mean neck-shaft angle increased from 117.8° to 129.8°, and the articulo-trochanteric distance has improved from −6.7 to 20.8 mm. Six out of 21 patients required staged periacetabular osteotomy for residual acetabular dysplasia. No cases of chondrolysis or osteonecrosis were identified. Conclusion: Femoral neck lengthening osteotomy through surgical hip dislocation appraoch has proven to be safe and effective for preservation of symptomatic hips with Perthes and Perthes-like deformities and mild to moderate femoral head deformities (Stulberg II and III). A staged periacetabular osteotomy may be required in those patients with significant acetabular dysplasia. Level of evidence: Level IV.

Project description:BackgroundComplex proximal femoral deformities, including an elevated greater trochanter, short femoral neck, and aspherical head-neck junction, often result in pain and impaired hip function resulting from intra-/extraarticular impingement. Relative femoral neck lengthening may address these deformities, but mid-term results of this approach have not been widely reported.Questions/purposesDo patients who have undergone relative femoral neck lengthening show (1) less hip pain and greater function; (2) improved radiographic parameters; (3) significant complications requiring subsequent surgery; and (4) progression of osteoarthrosis (OA) or conversion to total hip arthroplasty (THA) at mid-term followup?MethodsWe retrospectively reviewed 40 patients (41 hips) with isolated relative femoral neck lengthening between 1998 and 2006 with sequelae of Legg-Calvé-Perthes disease (38 hips [93%]), slipped capital femoral epiphysis (two hips [5%]), and postseptic arthritis (one hip [2%]). During this time, the general indications for this procedure included a high-riding greater trochanter with a short femoral neck with abductor weakness and symptomatic intra-/extraarticular impingement. Mean patient followup was 8 years (range, 5-13 years), and complete followup was available in 38 patients (39 hips [95%]). We evaluated pain and function with the impingement test, limp, abductor force, Merle d'Aubigné-Postel score, and range of motion. Radiographic parameters included trochanteric height, alpha angle, and progression of OA. Subsequent surgeries, complications, and conversion to THA were summarized.ResultsThe proportion of positive anterior impingement tests decreased from 93% (38 of 41 hips) preoperatively to 49% (17 of 35 hips) at latest followup (p = 0.002); the proportion of limp decreased from 76% (31 of 41 hips) to 9% (three of 35 hips; p < 0.001); the proportion of normal abductor strength increased from 17% (seven of 41 hips) to 91% (32 of 35 hips; p < 0.001); mean Merle d'Aubigné-Postel score increased from 14 ± 1.7 (range, 9-17) to 17 ± 1.5 (range, 13-18; p < 0.001); mean internal rotation increased to 25° ± 15° (range, 0°-60°; p = 0.045), external rotation to 32° ± 14° (range, 5°-70°; p = 0.013), and abduction to 37° ± 13° (range, 10°-50°; p = 0.004). Eighty percent of hips (33 of 41 hips) showed normal trochanteric height; alpha angle improved to 42° ± 10° (range, 27°-90°). Two hips (5%) had subsequent surgeries as a result of lack of containment; four of 41 hips (10%) had complications resulting in reoperation. Fourteen of 35 hips (40%) showed progression of OA; four of 40 hips (10%) converted to THA.ConclusionsRelative femoral neck lengthening in hips with combined intra- and extraarticular impingement results in reduced pain, improved function, and improved radiographic parameters of the proximal femur. Although lack of long-term complications is gratifying, progression of OA was not prevented and remains an area for future research.

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Impingement-free hip range of motion after osteochondroplasty and relative neck lengthening in adults with healed Perthes disease.

Publications

Impingement-free hip range of motion after osteochondroplasty and relative neck lengthening in adults with healed Perthes disease.

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