How to prevent graft resorption or breakage in shelf acetabuloplasty for Perthes disease with hinge abduction – A modified Staheli technique successful in 31 hips in midterm results

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Abstract

BACKGROUND: Shelf acetabuloplasty covers the hip and allows remodeling in hips with Legg-Calvé-Perthes disease and hinge abduction. Graft resorption or breakage is a bad complication that necessitate another surgical procedure.

AIM: Our report evaluates a modified Staheli technique for graft resorption or breakage.

MATERIALS AND METHODS: Case series study of 31 hips (29 patients) with mean age at operation was 8.1 (range 6-14 years). Duration of complaint ranged between one year and up to three years with the mean duration 1.52 ± 0.76 years. The different parameters evaluating the hip as: Tönnis angle, Sharp angle, center-edge angle, and acetabular coverage percentage were measured. For unilateral cases only, medial joint space ratio and epiphyseal height ratio were evaluated.

RESULTS: The mean postoperative follow-up was 47.8 ± 9.8 months. All studied joints had Catterall type IV, Salter-Thompson classification type B. Seven joints were in Fragmentation stage whereas 24 joints were in re-ossification stage. Based on Lateral Pillar classification; only two joints were classified as B/C and 29 joints were classified as C. Final follow up internal rotation, abduction, center-edge angle, and acetabular coverage percentage were found to be significantly higher. In contrast, Tönnis angle and Sharp’s angle were significantly decreased. For unilateral cases, it was found that medial joint space ratio and epiphyseal height ratio were significantly decreased. None of the hips had resorbed or broken graft till final follow up.

CONCLUSIONS: This modified Staheli technique prevent graft resorption or breakage. Shelf provides a good acetabular coverage for the deformed aspherical head with Legg-Calvé-Perthes disease and hinge abduction to improve hip clinical and radiological outcome.

About the authors

Nariman Abol Oyoun

Assiut University Hospital

Email: n.aboloyoun@aun.edu.eg
ORCID iD: 0000-0003-1847-8056

MD

Egypt, Assiut

Mohamed Khaled

Assiut University Hospital

Email: mohamed.khaled@aun.edu.eg
ORCID iD: 0000-0002-6235-2090

MD

Egypt, Assiut

Hesham Mohamed Elbaseet

Assiut University Hospital

Author for correspondence.
Email: drhesham20@aun.edu.eg
ORCID iD: 0000-0001-5362-2362

MD, Orthopedic and Traumatology Department

Egypt, Assiut

Abdel Khalek Hafez Ibrahim

Assiut University Hospital

Email: abdelkhalekhafezortho@med.aun.edu.eg
ORCID iD: 0000-0002-1283-2512

MD, Professor

Egypt, Assiut

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2. Fig. 1. Hinge Abduction Illustration: a — normal hip in neutral position; b — deformed hip with superiolateral bump in neutral position; c — normal hip in abduction rotates around axis in the centre of the head; d — deformed hip hinges around axis at the superiolateral margin during abduction with medial joint space widening

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3. Fig. 2. Ten years old male with Legg-Calvé-Perthes disease right hip. Pre-operative x rays: a — anterio-posterior pelvis; b — lateral frog position. Intraoperative hip arthrogram showing hinge abduction; c — neutral; d — in abduction; e — direction of slot of shelf; f — after Shelf placement; g — diagram shows Trapezoidal shaped shelf with cancellous fragments at the edge of iliac bone; h — preoperative abduction. After 3 years follow up: i and j — postoperative range of motion; k — anterio-posterior pelvis; l — lateral frog position. RHRF — reflected head of Rectus Femoris

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Copyright (c) 2021 Abol Oyoun N., Khaled M., Mohamed Elbaseet H., Hafez Ibrahim A.

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