TRIPLE PELVIC OSTEOTOMY IN SEVERE LEGG-CALVE-PERTHES DISEASE

Abstract

Treatment of severe Perthes disease remains a major challenge. Various surgical options exist for containment. We describe the Birmingham interlocking triple pelvic osteotomy (BITPO) and report the results at skeletal maturity.

We reviewed 22 hips in 21 consecutive patients with severe Perthes who had the BITPO. There were 16 males and 5 females. The mean age at presentation was 7 years 7 months. Seventeen hips were Herring group C and five were Herring group B. Six patients had four head-at-risk signs (HARS), 9 had three HARS, 4 had two HARS and 3 had a single HARS. The mean age at operation was 8 years 2 Months.

Clinical, radiological and functional evaluations were under taken on these patients who have since reached skeletal maturity. The minimum follow up was 6 years. Average age at review was 18 years 8 months (range 16–25). Two patients have since had hip resurfacing, and two patients a double femoral osteotomy and one patient a surgical dislocation of the hip and valgus osteotomy.

The average Harris Hip Score pre-operatively was 52, which improved to a mean score of 82. Eleven hips were classified as Stulberg I/II (50%), 9 hips Stulberg III/IV (41%) and 2 hips Stulberg V (9%). The average increase in Centre-Edge angle was 31 degrees and there was an average improvement of 24.6% in the head coverage. At follow up the average abduction was 31 degrees (improvement of 8.5 degrees), internal rotation 22 degrees (10.5 degree improvement) and flexion 106 degrees (11 degree improvement).

We conclude that the Birmingham interlocking triple pelvic osteotomy provides excellent coverage of the femoral head in severe Perthes disease, recaptures and remoulds the deformed head and avoids retroversion of socket. Good results in severe Perthes disease are maintained beyond skeletal maturity.