Outcomes in advanced Legg-Calvé-Perthes disease treated with the Staheli procedure

Abstract

Background: Containment and preservation of hip range of motion have been the principles governing the treatment of Legg-Calvé-Perthes disease. The Staheli's slotted acetabular augmentation (SAA) procedure is an alternative approach for older children with Perthes disease with lateral subluxation, incongruent hip, and abduction hinge. It provides effective coverage, restricts lateral displacement of the femoral head, and achieves containment and congruency in short-term follow-up.

Materials and methods: This study evaluated pre- and postoperative symptoms, range of motion (ROM), and radiographic images in advanced Perthes disease with an incongruent hip or hinge abduction in lateral pillar groups B and C of 21 children who underwent a SAA procedure.

Results: Postoperative evaluation showed improved abduction, internal rotation, subluxation ratio, femoral head ratio, and acetabular coverage. At final follow-up, ROM of abduction went from 20° preoperatively to 45° postoperatively, and internal rotation went from 15° preoperatively to 35° postoperatively. The radiographic findings revealed 33% and 38% of patients achieved spherical congruence of the hip and an ovoid or mushroom femoral head, respectively.

Conclusion: SAA restricts lateral displacement or subluxation of the femoral head and preserves sphericity, resulting in containment and acetabular coverage.