Management of residual hip deformities secondary to Legg–Calve–Perthes disease in adults: a systematic review

Mohammed T Omar, A. Sultan, M. Ismail
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Abstract

Background The objective of this study is to systematically review the results of different studies related to the management of hip deformities secondary to Perthes’ disease in adults. Patients and methods Thirteen studies matching the inclusion and exclusion criteria, totaling 316 adults including 326 hips that underwent 119 surgical hip dislocation (SHD), 49 periacetabular osteotomy, 111 SHD with periacetabular osteotomy, 16 intertrochanteric osteotomy with acetabular roof plasty, and 31 adductor tenotomy with cheilectomy of the femoral head. Their age was in the range from 19 to 42 years with clinical follow-up range (16–135 months). The degree of pain, function, range of movements, and deformities were evaluated. Results The SHD approach has a 360° view allowing full dynamic evaluation of the hip joint, identification, and correction of the most common residual deformations, leading to functional improvement and pain relief with low complication rates. Harris hip score was a common clinical parameter in a lot of studies and showed improvement from the average range (60–68.5) before surgery to 72–95 after it. In all, 188 hips were reported to have reduction in pain at last follow-up, but adequate clinical follow-up were not available for 112 hips. However, 26 patients were reported as a failure (defined as total hip arthroplasty or persistent or increased pain). Onset osteoarthritis advancement cannot be prevented in hips. Conclusion SHD provides the opportunity to achieve any kind of simultaneous femoral and acetabular osteotomies leading to functional improvement and pain relief with low complication rates.
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成人legg - calf - perthes病继发残余髋关节畸形的处理:系统综述
背景:本研究的目的是系统回顾与成人Perthes病继发髋关节畸形治疗相关的不同研究结果。患者和方法13项研究符合纳入和排除标准,共计316例成人,其中326例髋关节接受手术脱位(SHD), 49例髋臼周围截骨,111例SHD合并髋臼周围截骨,16例股骨粗隆间截骨合并髋臼顶成形术,31例内收肌腱切断术合并股骨头颧骨切除术。年龄19 ~ 42岁,临床随访16 ~ 135个月。评估疼痛程度、功能、活动范围和畸形。SHD入路具有360°的视野,可以对髋关节进行全面的动态评估,识别和纠正最常见的残余变形,从而改善功能和减轻疼痛,并发症发生率低。Harris髋关节评分是许多研究中常见的临床参数,从手术前的平均范围(60-68.5)改善到手术后的72-95。在最后一次随访中,总共有188个髋关节疼痛减轻,但112个髋关节没有得到充分的临床随访。然而,26例患者报告为失败(定义为全髋关节置换术或持续或增加的疼痛)。髋部骨关节炎的发病进展是无法预防的。结论SHD为实现任何类型的股骨和髋臼同时截骨提供了机会,可改善功能,减轻疼痛,并发症发生率低。
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