In general the procedures performed through the SHD approach has allowed functional improvement and pain relief with a low rate (6%) of complications. About 40% of patients were reported to be pain free at last follow-up. Seventy-five percent of patients showed improvement in symptoms. However, 10% of patients had worsening pain and underwent a total hip arthroplasty. The rate of failure (defined as total hip arthroplasty or persistent pain) was about 16%.
Further studies are necessary to elucidate the question of whether or not reshaping the proximal femur and eliminating FAI affects the long-term outcome and prevents the development/progression of hip osteoarthritis in the healed LCPD hip.
1. Stulberg SD, Cooperman DR, Wallensten R.The natural history of Legg-Calve-Perthes
disease.J Bone Joint Surg Am.1981;63:1095–1108.
2. Yrjonen T.Long-term prognosis of Legg-Calve-Perthes
disease: a meta-analysis.J Pediatr Orthop B.1999;8:169–172.
3. Zilkens C, Bittersohl B, Jager M, et al..Clinical presentation of young adults after Legg-Calve-Perthes
disease.Acta Orthop Belg.2009;75:754–760.
4. Catterall A.Adolescent hip
pain after Perthes
’ disease.Clin Orthop Relat Res.1986;209:65–69.
5. Ippolito E, Tudisco C, Farsetti P.The long-term prognosis of unilateral Perthes
’ disease.J Bone Joint Surg Br.1987;69:243–250.
6. Larson AN, Sucato DJ, Herring JA, et al..A prospective multicenter study of Legg-Calve-Perthes
disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years.J Bone Joint Surg Am.2012;9999:584–592.
7. Grossbard GD.Hip
pain during adolescence after Perthes
’ disease.J Bone Joint Surg Br.1981;63B:572–574.
8. Snow SW, Keret D, Scarangella S, et al..Anterior impingement of the femoral head: a late phenomenon of Legg-Calve-Perthes
’ disease.J Pediatr Orthop.1993;13:286–289.
9. Quain S, Catterall A.Hinge abduction of the hip
. Diagnosis and treatment.J Bone Joint Surg Br.1986;68:61–64.
10. Myers GJ, Mathur K, O’Hara J.Valgus osteotomy: a solution for late presentation of hinge abduction in Legg-Calve-Perthes
disease.J Pediatr Orthop.2008;28:169–172.
11. Yoo WJ, Choi IH, Chung CY, et al..Valgus femoral osteotomy for hinge abduction in Perthes
’ disease. Decision-making and outcomes.J Bone Joint Surg Br.2004;86:726–730.
12. Garceau G.Surgical treatment of coxa plana.J Bone Joint Surg Br.1964;46-B:779–780.
13. Klisic PJ.Treatment of Perthes
’ disease in older children.J Bone Joint Surg Br.1983;65:419–427.
14. McKay DW.Cheilectomy of the hip
.Orthop Clin North Am.1980;11:141–160.
15. Rowe SM, Jung ST, Cheon SY, et al..Outcome of cheilectomy in Legg-Calve-Perthes
disease: minimum 25-year follow-up of five patients.J Pediatr Orthop.2006;26:204–210.
16. Joo SY, Lee KS, Koh IH, et al..Trochanteric advancement in patients with Legg-Calve-Perthes
disease does not improve pain or limp.Clin Orthop Relat Res.2008;466:927–934.
17. Ganz R, Gill TJ, Gautier E, et al..Surgical dislocation
of the adult hip
a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis.J Bone Joint Surg Br.2001;83:1119–1124.
18. Gautier E, Ganz K, Krugel N, et al..Anatomy of the medial femoral circumflex artery and its surgical implications.J Bone Joint Surg Br.2000;82:679–683.
19. Beck M, Kalhor M, Leunig M, et al..Hip
morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement
as a cause of early osteoarthritis of the hip
.J Bone Joint Surg Br.2005;87:1012–1018.
20. Beck M, Leunig M, Parvizi J, et al..Anterior femoroacetabular impingement
: part II. Midterm results of surgical treatment.Clin Orthop Relat Res.2004;418:67–73.
21. Ganz R, Parvizi J, Beck M, et al..Femoroacetabular impingement
: a cause for osteoarthritis of the hip
.Clin Orthop Relat Res.2003;417:112–120.
22. Leunig M, Ganz R.Femoroacetabular impingement
. A common cause of hip
complaints leading to arthrosis.Unfallchirurg.2005;108:9–102–7.
23. Eijer H, Berg RP, Haverkamp D, et al..Hip
deformity in symptomatic adult Perthes
’ disease.Acta Orthop Belg.2006;72:683–692.
24. Sankar WN, Flynn JM.The development of acetabular retroversion in children with Legg-Calve-Perthes
disease.J Pediatr Orthop.2008;28:440–443.
25. Kim HT, Wenger DR.“Functional retroversion” of the femoral head in Legg-Calve-Perthes
disease an d epiphyseal dysplasia: analysis of head-neck deformity and its effect on limb position using three-dimensional computed tomography.J Pediatr Orthop.1997;17:240–246.
26. Klaue K, Durnin CW, Ganz R.The acetabular rim syndrome. A clinical presentation of dysplasia of the hip
.J Bone Joint Surg Br.1991;73:423–429.
27. Ganz R, Huff TW, Leunig M.Extended retinacular soft-tissue flap for intra-articular hip
surgery: surgical technique, indications, and results of application.Instr Course Lect.2009;58:241–255.
28. Leunig M, Ganz R.Relative neck lengthening and intracapital osteotomy for severe Perthes
-like deformities.Bull NYU Hosp Jt Dis.2011;69suppl 1S62–S67.
29. Espinosa N, Beck M, Rothenfluh DA, et al..Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique.J Bone Joint Surg Am.2007;89suppl 2, pt136–53.
30. Shore BJ, Millis MB, Kim YJ.Vascular safe zones for surgical dislocation
in children with healed legg-calve-perthes
disease.J Bone Joint Surg Am.2012;94:721–727.
31. Ganz R, Horowitz K, Leunig M.Algorithm for femoral and periacetabular osteotomies in complex hip
deformities.Clin Orthop Relat Res.2010;468:3168–3180.
32. Albers CE, Steppacher SD, Ganz R, et al..Joint-preserving surgery improves pain, range of motion, and abductor strength after Legg-Calve-Perthes
disease.Clin Orthop Relat Res.2012;470:2450–2461.
33. Anderson LA, Erickson JA, Severson EP, et al..Sequelae of Perthes
disease: treatment with surgical hip
dislocation and relative femoral neck lengthening.J Pediatr Orthop.2010;30:758–766.
34. Eijer H, Podeszwa DA, Ganz R, et al..Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes
35. Kim YJ, Novais EN.Diagnosis and treatment of femoroacetabular impingement
disease.J Pediatr Orthop.2011;31supplS235–S240.
36. Novais EN, Clohisy J, Siebenrock K, et al..Treatment of the symptomatic healed Perthes hip
.Orthop Clin North Am.2011;42:401–417viii.
37. Paley D.The treatment of femoral head deformity and coxa magna by the Ganz femoral head reduction osteotomy.Orthop Clin North Am.2011;42:389–399viii.
38. Rebello G, Spencer S, Millis MB, et al..Surgical dislocation
in the management of pediatric and adolescent hip
deformity.Clin Orthop Relat Res.2009;467:724–731.
39. Shore BJ, Novais EN, Millis MB, et al..Low early failure rates using a surgical dislocation
approach in healed Legg-Calve-Perthes
disease.Clin Orthop Relat Res.2012;470:2441–2449.
40. Ross JR, Nepple JJ, Baca G, et al..Intraarticular abnormalities in residual Perthes
deformities.Clin Orthop Relat Res.2012;470:2968–2977.
41. Shin SJ, Kwak HS, Cho TJ, et al..Application of Ganz surgical hip
dislocation approach in pediatric hip
diseases.Clin Orthop Surg.2009;1:132–137.