Labral Support Shelf Acetabuloplasty for Late Presenting Perthes Disease: Outcomes in Indian Patients

Udit Vinayak; Chaitrali Gundawar; Ashok Shyam; Parag Sancheti; Sandeep V Vaidya; Mandar V Agashe; Sandeep Patwardhan

doi:10.1007/s43465-023-00978-4

Labral Support Shelf Acetabuloplasty for Late Presenting Perthes Disease: Outcomes in Indian Patients

Indian J Orthop. 2023 Sep 3;57(11):1785-1792. doi: 10.1007/s43465-023-00978-4. eCollection 2023 Nov.

Authors

Udit Vinayak¹, Chaitrali Gundawar², Ashok Shyam¹, Parag Sancheti¹, Sandeep V Vaidya³, Mandar V Agashe⁴, Sandeep Patwardhan^{1

5}

Affiliations

¹ Department of Orthopaedic surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
² Department of Paediatric Orthopaedics, SRCC Children's hospital, Haji Ali, Mumbai, India.
³ Department of Paediatric Orthopaedics, Pinnacle OrthoCentre hospital, Thane, India.
⁴ Agashe's Paediatric SuperSpeciality Clinic, MN Road, Kurla West, Mumbai, 400070 India.
⁵ Paediatric Orthopaedic Services, Department of Orthopaedic Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.

Abstract

Introduction: The treatment of late-presenting Perthes disease with extrusion is controversial and debatable. One of the options available is the labral shelf acetabuloplasty (LSA).

Aim: The aim of the study was to evaluate the results of LSA in late-presenting Perthes disease in terms of clinic-radiological outcome measures.

Materials and methods: A retrospective analysis of prospectively collected data of patients with late presenting Perthes disease (Elizabethtown stage 2B onwards) treated by LSA by 2 experienced paediatric orthopaedic surgeons was performed. Data was collected of clinical parameters such as hip range of motion(ROM) and Harris Hip score and radiological parameters such as acetabular height, width and volume, shelf width, Centre Edge angle(CEA) and the lateral extrusion.

Results: Thirty-five patients (28 males and 7 females) treated between 2012 to 2019 were analyzed. Majority were in Elizabethtown stage 3A (23) followed by 2B and 3B (12 each). At a mean follow up of 36 months, the hip ROM and the Harris Hip Score (from 65 ± 3.5 to 81.33 ± 7.12) improved significantly and there was a statistically significant improvement in terms of all radiological parameters. Majority of the hips were in Stulberg grade 3 (20) followed by grade 1 and 2 (7 each) and Stulberg 4 (1). There were no major complications in any of the patients of the series.

Conclusion: Labral support shelf acetabuloplasty is a valuable surgery for late presenting Perthes disease and helps in maintenance of good coverage and allows restoration of range of motion over time.

Keywords: Elizabethtown classification; Perthes Disease; Shelf acetabuloplasty; Varus osteotomy.

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