Comparative study between lateral shelf acetabuloplasty and combined procedure of lateral shelf acetabuloplasty with trochanteric epiphysiodesis in cases of Legg-Calves-Perthes disease — a retrospective study

Legg-Calves-Perthes disease (LCPD) has a poor outcome leading to disability and early onset of osteoarthritis. Patient aged less than 8 years have usually good prognosis and are usually managed conservatively. The primary goal is to achieve spherical and congruent femoral head to reduce the chance of further subluxation of femoral head and secondary arthritis of the hip. Methods. The study aimed to analyze the radiological and functional outcomes of group-A (LSA) and group-B (LSA and trochanteric epiphysiodesis) in cases of LCPD. Our study retrospectively analyzed 80 patients (45 in Group-A and 35 in Group-B) between 2008 and 2018, 63 patients were boys and 17 patients were girls. Patients who did not respond to the conservative treatment over the course of 6 months and patients with Caterall type-II and III were taken into the study. Radiological parameters like Center edge angle, sharp angle, medial joint space distance, epiphysis height ratio, acetabular coverage, neck-shaft angle, articulo-trochanteric distance was noted for comparing radiological outcome. Results. Most of the patients in both the groups were Catterall-III — 66.25 % and Catterall-II — 33.75 %. According to Stulberg classification, excellent outcome was seen in 22.2 % of group A patients & 37.1 % of group B patients. Similarly, 15.5 % patients in Group A and 5.7 % patients in Group-B had bad outcome. Radiological and functional assessments were evaluated preoperatively and postoperatively till skeletal maturity which showed significant improvement in Group-B. 4 (8.8 %) patients in group-A and 3 (8.5 %) patients in group-B developed non-union & graft resorption was seen. Conclusions. Lateral shelf acetabuloplasty along with trochanteric epiphysiodesis helps in improving the neck shaft angle, gait, containment of subluxated head and maintains its congruity along with physiological remodeling. We recommend this combined procedure in cases of LCPD to counter the complications of early-onset arthritis and femoral head subluxation.