The Journal of Bone and Joint Surgery, Vol 73, Issue 9 1338-1347, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Shelf arthroplasty in patients who have Legg-Calve-Perthes disease. A study of long-term results
RW Kruse, JT Guille and JR Bowen
Alfred I. duPont Institute, Wilmington, Delaware 19899.
We reviewed the long-term functional and roentgenographic outcomes of
severe Legg-Calve-Perthes disease in two similar groups of patients, one of
which was managed with a shelf arthroplasty and the other, by a variety of
non-operative means. Twenty hips in nineteen patients were treated with
traction and, when necessary, adductor tenotomy to attempt reduction of the
subluxation; this was followed by a shelf arthroplasty to increase the arc
of the acetabulum and result in coverage of the femoral head. The average
duration of follow-up was nineteen years (range, two to forty-seven years).
The initial center-edge angle and the anteroposterior Mose sphericity
measurement were significantly improved at the most recent follow-up (p
greater than or equal to 0.05), and the average Iowa hip score was 91
points. Hinge abduction, which was producing incongruity, was eliminated in
eleven of fourteen hips after the operation. The outcomes for the second
group, consisting of eighteen hips in seventeen patients who were managed
non-operatively, were also reviewed, at an average duration of follow-up of
twenty-eight years (range, seven to forty-five years). No significant
improvement in the center-edge angle or the anteroposterior Mose sphericity
measurement was observed at the most recent follow-up, and the average Iowa
hip score was 81 points. There was no significant difference in the range
of motion of the hip between the groups. We believe that shelf arthroplasty
is a favorable option in the treatment of Legg-Calve-Perthes disease when
additional bone is needed at the lateral aspect of the acetabulum to cover
the extruded portion of the femoral head, to prevent additional incongruity
and thereby delay the early onset of degenerative changes.
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