A combined treatment strategy of Legg-Calve-Perthes disease with BEST quartet

Authors : Remzi Çaylak, Çağrı Örs, Emre Toğrul
Pages : 616-626
Doi:10.31362/patd.1445568
View : 136 | Download : 142
Publication Date : 2024-10-09
Article Type : Research Paper
Abstract :Purpose: The main pathology of Legg-Calvé-Perthes Disease (LCPD) is the disruption of blood flow of the femoral head resulting ischemic necrosis which leads hip joint incongruency. The most frequent methods in the treatment are the methods improving the containment of the femoral head. There are limited studies in the literature addressing the treatment of necrosis using methods such as epiphyseal drilling or distraction osteogenesis. Our study aimed to investigate the mid-long-term outcomes of LCPD patients treated with the BEST method, which aims to improve congruency and containment simultaneously. Materials and methods: LCPD patients (23 male, 1 female) who were treated with (B)leeding the epiphysis by drilling, (E)vacuation of the joint synovitis, contained with (S)alter’s Osteotomy, and distracted with skin (T)raction investigated retrospectively. Only patients who reached skeletal maturity at latest follow-up were included in the study. Patients’ final radiographs were classified according to the Stulberg classification, Mose classification, and Tönnis osteoarthritis classification. Results: The mean follow-up of the patients was 10.44±1.35 (8.5-13) years, and the mean age at the last followup was 17.71±1.73 (15.25-20.83) years. According to the Stulberg classification, 11 (45.8%) of the patients had a Class-I hip; 6 (25%) a Class-II hips; 3 (12.5%) a class-III hips, 4 (16.7%) a class-IV hips. According to the Mose classification, 12 (50%) of the patients had good results; 5 (20.8%) had fair results; 7 (29.1%) had poor results. Conclusion: BEST treatment method for LCPD is a combined procedure which addresses to all pathologies of disease at the same time. This combined treatment protocol may be preferred for severely affected LCPD cases who with subluxation especially in higher lateral pillar class that are prone to nonspherical incongruency
Keywords : Legg Calve Perthes hastalığı, Salter osteotomisi, femur başı osteonekrozu

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