Asep SANTOSO, Pramod Shaligram INGALE, Ik-Sun CHOI, Young-Rok SHİN, Kyung-Soon PARK, Taek-Rim YOON

Treatment outcome of dome osteotomy of the pelvis combined with trochanteric advancement for sequelae of Perthes' disease

Objective: Disparity in size between femoral head and acetabulum could promote premature degener-ation of the hip joint. The purpose of this study was to report the results of Kawamura's dome osteotomy for acetabular dysplasia due to sequelae of Perthes' disease. Patients and Methods: Fourteen patients (14 hips) operated between 1999 and 2012 were retrospectively reviewed. There were 9 males and 5 females with a mean age of 29 years (range, 15e54 years). Func-tional and radiological results were reviewed at mean follow-up of 9 years (range, 4e12 years). Results: Pain relief was obtained in 13 of 14 (92.8%) patients postoperatively. Good to excellent functional outcome was obtained in 10 of 14 (71.4%) patients. Mean Harris hip score was improved from 63 to 84 (p < 0.05) at the final follow-up. Improvement of limping gait was observed in 10 of 14 (71.4%) patients. Center edge angle improved from mean 24 (11e36 ) preoperatively to mean 35 (27e46 ) postoperatively (p < 0.05), acetabular angle improved from mean 43 (36e49 ) preoperatively to mean 37 (32e44 ) postoperatively (p < 0.05), acetabular head index improved from mean 69% (50e83%) preoperatively to mean 85% (73e100%) postoperatively (p < 0.05). Progression of arthrosis stage occurred in 3 of 14 (21%) patients. None of the hip with preoperative Stulberg III, 2 of 9 hips with Stulberg IV and 2 of 2 hips with Stulberg V needed conversion to total hip arthroplasty during the follow-up. Conclusion: Dome osteotomy of the pelvis combined with trochanteric advancement could give a reasonable treatment outcome for acetabular dysplasia due to Perthes' disease at mid to long-term follow-up. Advanced stage of arthrosis, preoperative Stulberg V and no improvement of limping gait after the surgery possibly associated with poor outcome. Level of evidence: Level IV, therapeutic study. © 2018 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).

___

18. Koyama K, Higuchi F, Inoue A. Modified Chiari osteotomy for arthrosis after Perthes' disease. 14 hips followed for 2-12 years. Acta Orthop Scand. 1998;69: 129e132.

17. Migaud H, Duquennoy A, Gougeon F, Fontaine C, Pasquier G. Outcome of Chiari pelvic osteotomy in adults. 90 hips with 2-15 years' follow-up. Acta Orthop Scand. 1995;66:127e131.

16. Osebold WR, Lester EL, Watson P. Dynamics of hip joint remodeling after Chiari osteotomy. 10 patients with neuromuscular disease followed for 8 years. Acta Orthop Scand. 1997;68:128e132.

15. Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calve-Perthes disease. J Bone Joint Surg Am. 1981;63:1095e1108.

14. Higuchi F, Inoue A. Chiari pelvic osteotomy using lateral approach. Orthop Surg Trauma. 1995;38:331e337 [in Japanese].

13. Heyman CH, Herndon CH. Legg-Perthes disease; a method for the measure-ment of the roentgenographic result. J Bone Joint Surg Am. 1950;32A:767e778.

12. Sharp IK. Acetabular dysplasia: the acetabular angle. J Bone Joint Surg Br. 1961;43:268e272.

11. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteoarthrosis. Acta Chir Scand. 1939;83:29e37.

10. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737e755.

9. Hu QS, Ul-Haq R, Park KS, Yoon TR, Lee KB. Dome osteotomy of the pelvis using a modified trochanteric osteotomy for acetabular dysplasia. Int Orthop. 2012;36:9e15.

8. Sakai T, Nishii T, Takao M, Ohzono K, Sugano N. High survival of dome pelvic osteotomy in patients with early osteoarthritis from hip dysplasia. Clin Orthop Relat Res. 2012;470:2573e2582.

7. Anwar MM, Sugano N, Matsui M, Takaoka K, Ono K. Dome osteotomy of the pelvis for osteoarthritis secondary to hip dysplasia. An over five-year follow-up study. J Bone Joint Surg Br. 1993;75:222e227.

6. Kawamura B. The transverse pelvic osteotomy. J Jpn Orthop Assoc. 1959;32: 1181e1188.

5. Reddy RR, Morin C. Chiari osteotomy in Legg-Calve-Perthes disease. J Pediatr Orthop B. 2005;14:1e9.

4. Chiari K. Medial displacement osteotomy of the pelvis. Clin Orthop Relat Res. 1974;98:55e71.

3. Karami M, Fitoussi F, Ilharreborde B, Penneçot GF, Mazda K, Bensahel H. The results of Chiari pelvic osteotomy in adolescents with a brief literature review. J Child Orthop. 2008;2:63e68.

2. Reynolds DA. Chiari innominate osteotomy in adults. Technique, indications and contra indications. J Bone Joint Surg Br. 1986;68:45e54.

1. Bennett JT, Mazurek RT, Cash JD. Chiari's osteotomy in the treatment of Perthes' disease. J Bone Joint Surg Br. 1991;73:225e228.