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Tönnis triple pelvic osteotomy for Legg-Calve-Perthes disease

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Abstract

Purpose

The aim of this study is to evaluate the efficacy of Tönnis triple pelvic osteotomy in patients with LCP disease.

Methods

Between 2007 and 2011, Tönnis triple pelvic osteotomy was performed for 43 patients with LCP, in our institute. During the follow-ups of patients with LCP the indications for the surgery were lateralization of the femoral head, insufficient femoral head coverage and subluxation of the femoral head. The mean age of patients at the time of surgery was 9.4 years.

Results

Before surgical intervention, according to Waldenstrom classification, three patients were in the necrosis stage (7 %), six patients in the fragmentation stage (13.9 %), 16 patients in the re-ossification stage (37.2 %) and 18 patients in the remodeling stage (41.9 %). According to Herring classification, four patients were in group B (9.3 %), one patient in group B/C (2.3 %) and 38 patients in group C (88.4 %).

After the operation, patients were evaluated with Stulberg classification, and good outcome (Stulberg I/II) was achieved in 23 patients (53, 5 %), fair outcome (Stulberg III) in 16 patients (37, 2 %) and poor outcome (Stulberg IV/V) was seen in only four patients (9.3 %). The mean value of CEA was 0.37° pre-operatively and in the last follow-ups the mean value of CEA was 23.7°.

Conclusions

We recommend triple pelvic osteotomy for patients with LCP when conservative methods are not successful. According to our results we believe that Waldenstrom classification is a better option than Herring classification to determine the prognosis of disease after containment surgery.

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References

  1. Daniel AB, Shah H, Kamath A, Guddettu V, Joseph B (2012) Environmental tobacco and wood smoke increase the risk of Legg-Calvé-Perthes disease. Clin Orthop Relat Res 470(9):2369–2375

    Article  PubMed Central  PubMed  Google Scholar 

  2. Hosalkar HS, Mulpuri K (2012) Legg-Calvé-Perthes disease: where do we stand after 100 years? Editorial comment. Clin Orthop Relat Res 470(9):2345–2346

    Article  PubMed Central  PubMed  Google Scholar 

  3. Perthes G (2012) The classic: On juvenile arthritis deformans. Clin Orthop Relat Res 470(9):2349–2368

    Article  PubMed Central  PubMed  Google Scholar 

  4. Manig M (2013) Legg-Calvé-Perthes disease (LCPD). Principles of diagnosis and treatment. Orthopade 42(10):891–902, quiz 903–4

    Article  CAS  PubMed  Google Scholar 

  5. Tannast M, Hanke M, Ecker TM, Murphy SB, Albers CE, Puls M (2012) LCPD: reduced range of motion resulting from extra- and intraarticular impingement. Clin Orthop Relat Res 470(9):2431–2440

    Article  PubMed Central  PubMed  Google Scholar 

  6. Westhoff B, Martiny F, Krauspe R (2013) Current treatment strategies in Legg-Calvé-Perthes disease. Orthopade 42(12):1008–1017

    Article  CAS  PubMed  Google Scholar 

  7. Tönnis D, Kalchschmidt K, Heinecke A (1998) Acetabular rotations y triple pelvic osteotomy by the Tönnis method. Orthopade 27(11):733–742

    PubMed  Google Scholar 

  8. Sokolovsky AM, Sokolovsky OA (2001) Posterior rotational intertrochanteric osteotomy of the femur in children and adolescents. Use in residual deformity of the femoral head after treatment for developmental dysplasia of the hip. J Bone Joint Surg (Br) 83(5):721–725

    Article  CAS  Google Scholar 

  9. Staheli LT, Chew DE (1992) Slotted acetabular augmentation in childhood and adolescence. J Pediatr Orthop 12(5):569–580

    Article  CAS  PubMed  Google Scholar 

  10. Fabry K, Fabry G, Moens P (2003) Legg-Calve-Perthes disease in patients under 5 years of age does not always result in a good outcome Personal experience and meta-analysis of the literature. J Pediatr Orthop B 12:222–227

    PubMed  Google Scholar 

  11. Yrjönen T (1999) Long-term prognosis of Legg-Calvé-Perthes disease: a meta-analysis. J Pediatr Orthop B 8(3):169–172

    Article  PubMed  Google Scholar 

  12. Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am 86-A(10):2121–2134

    PubMed  Google Scholar 

  13. Soeur R, De Racker C (1952) The anatomopathologic aspect of osteochondritis and the pathogenic theories which are relevant. I. Acta Orthop Belg 18:57–102

    CAS  PubMed  Google Scholar 

  14. Sponseller PD, Desai SS, Millis MB (1988) Comparison of femoral and innominate osteotomies for the treatment of Legg-Calve-Perthes disease. J Bone Boint Surg Am 70(8):1131–1139

    CAS  Google Scholar 

  15. Salter R (1973) Legg-Perthes’ disease. Treatment by innominate osteotomy. AAOS Instruc Course Lect 22:309–316

    Google Scholar 

  16. Kumar D, Bache CE, O’Hara JN (2002) Interlocking triple pelvic osteotomy in severe Legg-Calve-Perthes disease. J Pediatr Orthop 22(4):464–470

    PubMed  Google Scholar 

  17. Cahuzac J, Onimus M, Trottmann F (1990) Chiari pelvic osteotomy in Perthes’ disease. J Pediatr Orthop 10:163–166

    Article  CAS  PubMed  Google Scholar 

  18. Daly K, Bruce C, Catterall A (1999) Lateral shelf acetabuloplasty in Perthes’ disease. A review of the end of growth. J Bone Joint Surg (Br) 81(3):380–384

    Article  CAS  Google Scholar 

  19. Hsu JE, Baldwin KD, Tannast M, Hosalkar H (2012) What is the evidence supporting the prevention of osteoarthritis and improved femoral coverage after shelf procedure for Legg-Calvé-Perthes disease? Clin Orthop Relat Res 470(9):2421–2430

    Article  PubMed Central  PubMed  Google Scholar 

  20. Yoo WJ, Moon HJ, Cho TJ, Choi IH (2012) Does shelf acetabuloplasty influence acetabular growth and remodeling? Clin Orthop Relat Res 470(9):2411–2420

    Article  PubMed Central  PubMed  Google Scholar 

  21. Vukasinovic Z, Spasovski D, Vucetic C, Cobeljic G, Zivkovic Z, Matanovic D (2009) Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease. Int Orthop 33(5):1377–1383

    Article  PubMed Central  PubMed  Google Scholar 

  22. Wenger DR, Pandya NK (2011) Advanced containment methods for the treatment of Perthes disease: Salter plus varus osteotomy and triple pelvic osteotomy. J Pediatr Orthop 31(2 Suppl):s198–205

    Article  PubMed  Google Scholar 

  23. Wenger DR, Pring ME, Hosalkar HS, Caltoum CB, Lalonde FD, Bastrom TP (2010) Advanced containment methods for Legg-Calve-Perthes disease: results of triple pelvic osteotomy. J Pediatr Orthop 30(8):749–757

    Article  PubMed  Google Scholar 

  24. Reinker KA (2011) Shelf and/or reduction and containment surgery. Orthop Clin North Am 42(3):355–359, vii

    Article  PubMed  Google Scholar 

  25. Sucato DJ (2013) Role of femoral head surgery in skeletally mature Perthes disease. J Pediatr Orthop 33(Suppl 1):S70–S75

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Author notes

  1. Aysegul Bursali

    Present address: Dr. Aysegul Bursali - Private Office Pediatric Orthopaedics, Istanbul, Turkey

Authors and Affiliations

  1. Devrek State Hospital, Vedat Ali Özkan Cad, 67800, Devrek, Zonguldak, Turkey

    Ismet Yalkin Camurcu

  2. Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey

    Timur Yildirim, Sukru Sarper Gursu & Aysegul Bursali

  3. Dogubeyazit State Hospital, Dogubeyazit, Agri, Turkey

    Abdul Fettah Buyuk

  4. Erzincan University Hospital, Erzincan, Turkey

    Vedat Sahin

Authors
  1. Ismet Yalkin Camurcu
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  2. Timur Yildirim
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  3. Abdul Fettah Buyuk
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  4. Sukru Sarper Gursu
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  5. Aysegul Bursali
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Correspondence to Ismet Yalkin Camurcu.

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Camurcu, I.Y., Yildirim, T., Buyuk, A.F. et al. Tönnis triple pelvic osteotomy for Legg-Calve-Perthes disease. International Orthopaedics (SICOT) 39, 485–490 (2015). https://doi.org/10.1007/s00264-014-2585-6

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  • DOI: https://doi.org/10.1007/s00264-014-2585-6

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