CHIARI OSTEOTOMY FOR SUBLUXATED, COXA IRREGULARIS IN OLDER CHILDREN AND ADOLESCENTS

Abstract

Introduction: This study evaluated the clinical and radiological outcomes of Chiari osteotomy for severe coxa irregularis and subluxation of the femoral head.

Materials and Methods: The study group included patients with late Legg-Calvé-Perthes disease (6 patients), posttraumatic avascular necrosis (1 patient), and multiple epiphyseal dysplasia (1 patient). The mean age at surgery was 11.4 years (range, 6.8 to 14.7). The clinical parameters evaluated included changes in pain, limp, and range of motion of the hip. Radiographic measurements were made to determine the width of the medial and superior joint spaces, acetabular coverage, lateral epiphyseal extrusion, and the Stulberg classification.

Results: At a mean follow-up of 5 years (range, 1.1 to 11.0 years), pain disappeared completely in 5 patients or markedly decreased, enough to complete normal daily physical activities, in the remaining 3 patients. Limping gait disappeared completely in 2 patients, but the remaining 6 patients had minimal limps. All the components of the range of hip motion increased significantly. Acetabular coverage averaged 55% (range, 33 to 87%) before operation and 88% (range, 79 to 97%) at the final follow-up. Lateral epiphyseal extrusion was 49% (range, 39 to 83%) before operation, and 18% (range, 8 to 40%) at the final follow-up. Joint spaces were not changed significantly after surgery.

Discussion: In conclusion, Chiari osteotomy has its own indications, as a salvage procedure, for older children and adolescents with subluxated, severe coxa irregularis. The current study confirms the efficacy of the operation in terms of the functional and radiological improvements.