Abstract :
Introduction: Legg calves Perthes disease (LCPD) is caused mainly due to idiopathic osteonecrosis or AVN of the proximal femoral epiphysis leading to remodelling during period of development, this will gradually progress into onset of hip osteoarthritis depending upon the rate at which the sphericity and congruency of the femoral head deteriorate. LCPD is usually associated with a hinge abduction deformity, in this condition the major aspherical portion of the head is shifted laterally, in such deformity; Valgus intertrochanteric osteotomy has to been utilized for correction. Cheilectomy deals with excision of exuberant portion of femoral head epiphysis, thereby eliminating hinged abduction and facilitating containment, which also maintains the blood supply, buy protecting the surrounding soft tissue structures.
Materials and Methods: We have included 10 patients for this study, from age group 9-16yrs, between July 15th to April 18. The criteria for patient selection being primarily adolescent age with radiological evidence of LCPD, with coxa plana and decreased range of motion. Patient under 10 years of age and with history of previous surgeries have been excluded. All the patients were planned preoperatively and operated under spinal anaesthesia. Through posterior kocherlangenback approach, capsulotomy was doneposterior-superiorly and lateral protuberance was identified and excised. A common feature through most surgeries being femoro-acetabular impingement (CAM type) secondary to aspherical femoral head. There were a total of 7 cases of complex CAM type deformities and 3 pincer induced deformities. Postoperatively weight bearing and ROM was restricted for 4 weeks. Physiotherapy protocol was followed for improving ROM. Patients were followed at 4,8,12 weeks to evaluate clinical and radiological progress.
Results: Majority of the patient experienced improved pain after surgical intervention and 1 patient had worsening of pain at 3 months of followup. 2 patients had complication of delayed wound healing due to superficial infections. No further complications such as osteonecrosis and non-union were not observed.
Conclusion: Though this study we can conclude that osteochondroplasty of the femoral head and neck performed in conjunction with other procedures, through the surgical dislocation of hip approach has improved pain and restored function in a majority of the patients, while avoiding any dreaded complications. Although the results were satisfactory in a 3 month follow up, we may conclude that a long term follow up is needed for the efficacy of this method in restoration of painless joint function and avoidance of arthroplasty at a later date.
Keyword :
Surgical dislocation, Kocher – langenback approach, Perthes disease, Osteochondroplasty