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Batailler C. Accurate Preoperative Digital Planning: The First Mandatory Step to Success in Complex and Unusual Total Hip Arthroplasties: Commentary on an article by Babar Kayani, MBBS, BSc, FRCS(Tr&Orth), PhD, et al.: "The Wagner Cone Stem for Atypical Femoral Anatomy in Total Hip Arthroplasty. A Report of 320 Cases with Minimum 5-Year Follow-up". J Bone Joint Surg Am 2024; 106:e34. [PMID: 39167065 DOI: 10.2106/jbjs.24.00555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Affiliation(s)
- Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Univ Lyon, Université Claude Bernard Lyon, Villeurbanne, France
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2
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Oommen AT. Total hip arthroplasty for sequelae of childhood hip disorders: Current review of management to achieve hip centre restoration. World J Orthop 2024; 15:683-695. [PMID: 39165868 PMCID: PMC11331318 DOI: 10.5312/wjo.v15.i8.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 06/13/2024] [Accepted: 07/05/2024] [Indexed: 08/13/2024] Open
Abstract
Adults requiring total hip arthroplasty (THA) for childhood disorder sequelae present with shortening, limp, pain, and altered gait. THA, which can be particularly challenging due to altered anatomy, requires careful planning, assessment, and computed tomography evaluation. Preoperative templating is essential to establish the appropriate acetabular and femoral size. Information regarding neck length and offset is needed to ensure the proper options are available at THA. Hip centre restoration must be planned preoperatively and achieved intraoperatively with appropriate exposure, identification, and stable fixation with optimum-size components. Identifying the actual acetabular floor is essential as changes include altered anatomy, distortion of the margins and version changes. Proximal femur changes include anatomical variation, decreased canal diameter, cortical thickness, changes in anteversion, and metaphyseal and diaphyseal mismatch. Preoperative assessment should consist of limb assessment for variations due to prior surgical procedures. Evaluation of the shortening pattern with the relationship of the lesser trochanter to the teardrop would help identify and plan for subtrochanteric shortening osteotomy, especially in high-riding hips. The surgical approach must ensure adequate exposure and soft tissue release to achieve restoration of the anatomical hip centre. The femoral components may require modularity to enable restoration of anteversion and optimum fixation.
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Affiliation(s)
- Anil Thomas Oommen
- Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
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Tong Y, Ihejirika-Lomedico R, Rathod P, Deshmukh A. Approaching total hip arthroplasty after Legg-Calvé-Perthes disease: A case series and literature review. J Clin Orthop Trauma 2024; 53:102478. [PMID: 39040624 PMCID: PMC11260328 DOI: 10.1016/j.jcot.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Due to femoral head-neck deformities and hip joint incongruence, patients with Legg-Calvé-Perthes Disease (LCPD) commonly require total hip arthroplasty (THA) in the fifth and sixth decades of life. These patients present additional challenges to arthroplasty surgeons not only because of their complicated hip anatomy but also because patients may have undergone prior operative procedures in childhood and thus present with pre-existing proximal femoral deformities. THA in LCPD patients can be associated with peri-operative complications such as fracture or nerve injury, and the rate of reoperation has been reported to be higher in the LCPD population as compared to the general population undergoing THA. Despite this, multiple case reports and studies have shown the relative long-term success of THA in patients with history of LCPD. In particular, uncemented modular stems are a commonly used implant choice in such cases. This article reviews and discusses the technical considerations for THA in patients with LCPD and highlights three such cases.
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Affiliation(s)
- Yixuan Tong
- NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA
| | | | - Parthiv Rathod
- NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA
| | - Ajit Deshmukh
- NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA
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De Salvo S, Sacco R, Mainard N, Lucenti L, Sapienza M, Dimeglio A, Andreacchio A, Canavese F. Total hip arthroplasty in patients with common pediatric hip orthopedic pathology. J Child Orthop 2024; 18:134-152. [PMID: 38567046 PMCID: PMC10984158 DOI: 10.1177/18632521241229608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Literature regarding total hip arthroplasty for pediatric hip diseases is scarce. This review aims to portray the various orthopedic conditions of childhood that can lead to significant impairment of the hip joint and, ultimately, to total hip arthroplasty in adolescence and adulthood. Methods In total, 61 out of 3666 articles were selected according to (1) the diagnosis of one of the 12 pediatric hip pathologies (Legg-Perthes-Calvé disease, developmental dysplasia of the hip, slipped capital femoral epiphysis, neuromuscular hip dysplasia, post-traumatic avascular necrosis of the proximal femur, juvenile rheumatoid arthritis, achondroplasia, spondyloepiphyseal dysplasia, mucopolysaccharidosis, mucolipidosis, hip infections, and tumors) that required total hip arthroplasty; (2) minimum follow-up of 16 months; (3) assessed outcome with a clinical or radiologic score; (4) Methodological Items for Non-Randomized Studies quality score of 9 or higher. The following information for each pathology was retrieved: mean age at total hip arthroplasty, reason for total hip arthroplasty, type of total hip arthroplasty, surgical technique, mean follow-up, and outcomes. Results Overall, the mean age at total hip arthroplasty for pediatric hip disease is in the sixth and seventh decade, except for tumors and skeletal dysplasias. The reason for performing total hip arthroplasty is often osteoarthrosis and abnormal anatomy. Prosthesis types change based on patient's conditions and technological advances; custom-made implants are used for tumors, juvenile rheumatoid arthritis, and skeletal dysplasias; for other diseases, the most frequent are modular cementless implants. Outcomes are generally good, and all studies portray functional and pain improvements. Conclusion Total hip arthroplasty is performed more frequently than in the past in patients with pediatric hip pathologies; it enhances patients' quality of life by reducing pain and improving function. However, revision rate in these patients is not negligible.
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Affiliation(s)
- Sara De Salvo
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
| | - Ricardo Sacco
- Department of Orthopedic Surgery, CHU de Rouen, Rouen, France
| | - Nicolas Mainard
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
| | - Ludovico Lucenti
- Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - Marco Sapienza
- Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico-San Marco, University of Catania, Catania, Italy
| | - Alain Dimeglio
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Antonio Andreacchio
- Pediatric Orthopedic Surgery Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedic Surgery, Lille University Hospital and Faculty of Medicine, Lille, France
- Department of Pediatric Orthopedics, Lille University Center, Jeanne de Flandre Hospital, Lille Cedex, France
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Hasler J, Flury A, Hoch A, Cornaz F, Zingg PO, Rahm S. Total hip arthroplasty through the direct anterior approach for sequelae of Legg-Calvé-Perthes disease. Arch Orthop Trauma Surg 2023; 143:5935-5944. [PMID: 36806985 PMCID: PMC10449662 DOI: 10.1007/s00402-023-04791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Due to multiplanar deformities of the hip, total hip arthroplasty (THA) for sequelae of Legg-Calvé-Perthes disease (LCPD) is often technically demanding. This study aimed to compare the clinical and radiographic outcomes of patients with sequelae of LCPD undergoing THA through the direct anterior approach (DAA) and non-anterior approaches to the hip. METHODS All patients with sequelae of LCPD who underwent primary THA between 2004 and 2018 (minimum follow-up: 2 years) were evaluated and separated into two groups: THA through the DAA (Group AA), or THA through non-anterior approaches to the hip (Group non-AA). Furthermore, a consecutive control group of patients undergoing unilateral THA through the DAA for primary hip osteoarthritis (Group CC) was retrospectively reviewed for comparison. RESULTS Group AA comprises 14 hips, group non-AA 17 hips and group CC 30 hips. Mean follow-up was 8.6 (± 5.2; 2-15), 9.0 (± 4.6; 3-17) and 8.1 (± 2.2; 5-12) years, respectively. At latest follow-up, Harris Hip Score was 90 (± 20; 26-100), 84 (± 15; 57-100), and 95 (± 9; 63-100) points, respectively. Overall, 6 patients treated for LCPD (each 3 patient in the AA and non-AA group) developed postoperative sciatic nerve palsy, of which only one was permanent. Complication-related revision rate at the latest follow-up was 15% in the AA-group and 25% in the non-AA group, respectively. CONCLUSION THA through the DAA might be a credible option for the treatment of sequelae of LCPD with comparable complication rates and functional outcomes to non-anterior approaches.
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Affiliation(s)
- Julian Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Xiao YB, Du W, Wu PF, Qing LM, Yu F, Tang JY. Pedicled iliac bone flap grafting in the treatment of late presentation Legg–Calvé–Perthes disease. Front Surg 2023; 10:926109. [PMID: 37066005 PMCID: PMC10090281 DOI: 10.3389/fsurg.2023.926109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundLegg–Calvé–Perthes disease (LCPD) is a juvenile form of ischemic femoral head osteonecrosis affecting children. The lack of effective and timely treatment results in severe sequelae in children (especially older ones). Although LCPD has been widely studied, little is known about its etiology. As a result, its clinical management is still challenging. This study will investigate the clinical and radiological results of patients older than 6 years and treated with pedicled iliac bone flap grafting for LCPD.Materials and methodsA total of 13 patients (13 hips) with late presentation of LCPD were treated with pedicled iliac bone flap grafting. Of the 13 patients, 11 were male and 2 were female. The average age of the patients was 8.4 years (range 6–13). Preoperational radiographs and pain scores were analyzed for lateral pillar classification and the Oucher scale. The final follow-up radiograph was classified using a modified Stulberg classification. Limping, extremity length inequality, and range of motion were clinically assessed.ResultsThe average follow-up of the patients was 70 months (range 46–120). During the surgery, seven hips were found to be lateral pillar grade B, two were grade B/C, and four were grade C. In the final examination, 12 hips were evaluated as good (Stulberg class I or II) and one as medium (Stulberg class III). There was limb shortening in one patient who was Stulberg class III. There was a significant difference between the preoperational and postoperational radiographic values and the Ocher scale, regardless of the surgical staging (P < 0.05).ConclusionsPedicled iliac bone flap graft can treat LCPD accompanied by pain and lateral pillar stage B, B/C, and C in children over 6 years.Level of EvidenceLevel IV—case series.
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Affiliation(s)
- Yong-bing Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Du
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Rehabilitation Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Pan-feng Wu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Li-ming Qing
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Fang Yu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ju-Yu Tang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Ju-Yu Tang
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Relative Femoral Neck Lengthening in Legg-Calvé-Perthes Total Hip Arthroplasty. Arthroplast Today 2022; 15:61-67. [PMID: 35399986 PMCID: PMC8991231 DOI: 10.1016/j.artd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/16/2022] [Accepted: 02/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background Total hip replacement (THR) in patients with a history of Legg-Calvé-Perthes disease can be a technically challenging procedure due to the distorted hip morphology. We propose a technique in which THR is preceded by a modified relative femoral neck lengthening (RFNL) procedure. Hereby, we aim to restore the biomechanical parameters. Methods Twenty-eight patients underwent RFNL in preparation of a second-stage THR between December 2011 and September 2019. The mean age was 38.1 ± 11.4 years. Radiographs were analyzed for centrotrochanteric distance, lateral displacement of the greater trochanter, and leg length discrepancy to assess the biomechanical restoration. Complication rate, reoperation rate, and patient-reported outcome measures were measured. Results Mean centrotrochanteric distance increased from −18.7 ± 6.7 mm preoperatively to 1.9 ± 9.0 mm (P < .001) after RFNL and to 11.4 ± 10.4 mm after THR (P < .001). Mean lateral displacement of the greater trochanter increased from 34.2 ± 8.1 mm preoperatively to 42.4 ± 5.2 mm (P < .001) after RFNL and to 49.9 ± 8.3 mm after THR (P < .001). Leg length discrepancy decreased from 17.5 ± 10.5 mm to 2.7 ± 2.2 mm after THR (P < .001). Mean Harris Hip Score improved from 56.9 ± 17.6 preoperatively to 89.4 ± 10.7 at the latest follow-up (P < .001). Eight patients (8 hips) postponed THR because of sufficient clinical improvement, at a mean follow-up of 4.2 ± 2.1 years. Two hips needed a revision RFNL due to non-union (7.1%), and 1 hip replacement was revised due to a deep infection (5.0%). Conclusions RFNL prior to THR in patients with end-stage osteoarthritis following Legg-Calvé-Perthes disease allows for utilizing regular implants with straight access to the femoral canal, with restored biomechanics and restoration of leg length. The prominent overhanging greater trochanter is reduced to prevent postoperative extra-articular impingement.
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McGuire MF, Vakulenko-Lagun B, Millis MB, Almakias R, Cole EP, Kim HKW. What is the adult experience of Perthes' disease? : initial findings from an international web-based survey. Bone Jt Open 2022; 3:404-414. [PMID: 35535518 PMCID: PMC9134832 DOI: 10.1302/2633-1462.35.bjo-2021-0185.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS Perthes' disease is an uncommon hip disorder with limited data on the long-term outcomes in adulthood. We partnered with community-based foundations and utilized web-based survey methodology to develop the Adult Perthes Survey, which includes demographics, childhood and adult Perthes' disease history, the University of California Los Angeles (UCLA) Activity Scale item, Short Form-36, the Hip disability and Osteoarthritis Outcome Score, and a body pain diagram. Here we investigate the following questions: 1) what is the feasibility of obtaining > 1,000 survey responses from adults who had Perthes' disease using a web-based platform?; and 2) what are the baseline characteristics and demographic composition of our sample? METHODS The survey link was available publicly for 15 months and advertised among support groups. Of 1,505 participants who attempted the Adult Perthes survey, 1,182 completed it with a median timeframe of 11 minutes (IQR 8.633 to 14.72). Participants who dropped out were similar to those who completed the survey on several fixed variables. Participants represented 45 countries including the USA (n = 570; 48%), UK (n = 295; 25%), Australia (n = 133; 11%), and Canada (n = 46; 4%). Of the 1,182 respondents, 58% were female and the mean age was 39 years (SD 12.6). RESULTS Ages at onset of Perthes' disease were < six years (n = 512; 43%), six to seven years (n = 321; 27%), eight to 11 years (n = 261; 22%), and > 11 years (n = 76; 6%), similar to the known age distribution of Perthes' disease. During childhood, 40% (n = 476) of respondents had at least one surgery. Bracing, weightbearing restriction, and absence of any treatment varied significantly between USA and non-USA respondents (p < 0.001, p = 0.002, and p < 0.001, respectively). As adults, 22% (n = 261) had at least one total hip arthroplasty, and 30% (n = 347) had any type of surgery; both more commonly reported among women (p = 0.002). CONCLUSION While there are limitations due to self-sampling, our study shows the feasibility of obtaining a large set of patient-reported data from adults who had childhood Perthes' from multiple countries. Cite this article: Bone Jt Open 2022;3(5):404-414.
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Affiliation(s)
- Molly F. McGuire
- Department of Orthopedic Research, Scottish Rite for Children, Dallas, Texas, USA
| | | | - Michael B. Millis
- Department of Orthopedics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Roi Almakias
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Earl P. Cole
- Perthes Kids Foundation, Los Angeles, California, USA
| | - Harry K. W. Kim
- Department of Orthopedic Research, Scottish Rite for Children, Dallas, Texas, USA
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - A study from the International Perthes Study Group
- Department of Orthopedic Research, Scottish Rite for Children, Dallas, Texas, USA
- Department of Statistics, University of Haifa, Haifa, Israel
- Department of Orthopedics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Perthes Kids Foundation, Los Angeles, California, USA
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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9
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Total Hip Arthroplasty in Patients With Severe Chronic Pubic Diastasis. Arthroplast Today 2022; 14:189-193. [PMID: 35330667 PMCID: PMC8938874 DOI: 10.1016/j.artd.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/27/2022] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Total hip arthroplasty (THA) in patients with severe chronic pubic diastasis from either congenital or acquired causes presents an exceptionally difficult challenge that has rarely been addressed in the arthroplasty literature. The purpose of this paper is to present a series of THAs in patients with severe chronic pubic diastasis, asking the following research questions: (1) What is the survivorship and clinical outcomes after THA in patients with severe chronic pubic diastasis? And (2) What is the rate of complications after THA surgery in this challenging patient population? We additionally describe our algorithm for preoperative planning and rationale for surgical technique and implant position. Material and methods We retrospectively queried the prospective arthroplasty database of 2 high-volume referral centers, yielding 6 THA in 4 patients with severe chronic pubic diastasis (minimum 8 cm) with a mean follow-up of 2.7 years. We recorded baseline demographic and intraoperative variables, as well as survivorship, patient-reported outcomes (Hip disability and Osteoarthritis Outcome Score for Joint Replacement score), and incidence of complications. Results There were no failures reported (100% survivorship) at a mean follow-up of 2.7 years. Mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement scores improved from 36.0 preoperatively to 82.8 postoperatively. There were no infections, dislocations, fractures, or any major complications in the postoperative period. Conclusion THA for patients with severe chronic pubic diastasis remains a rare but challenging reconstructive procedure. Excellent outcomes can be achieved with adequate preparation, particularly regarding the acetabular component position. Understanding the nature of the hemipelvis deformity and meticulous templating using “normalized” views of the hip are important components to a successful preoperative plan.
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Tolk JJ, Eastwood DM, Hashemi-Nejad A. Leg length discrepancy in patients with Perthes' disease : a note of caution for the arthroplasty surgeon. Bone Joint J 2021; 103-B:1736-1741. [PMID: 34719271 DOI: 10.1302/0301-620x.103b11.bjj-2020-2583.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Perthes' disease (PD) often results in femoral head deformity and leg length discrepancy (LLD). Our objective was to analyze femoral morphology in PD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalization on proximal and subtrochanteric femoral lengths. METHODS All patients treated for PD in our institution between January 2013 and June 2020 were reviewed retrospectively. Patients with unilateral PD, LLD of ≥ 5 mm, and long-leg standing radiographs at skeletal maturity were included. Total leg length, femoral and tibial length, articulotrochanteric distance (ATD), and subtrochanteric femoral length were compared between PD side and the unaffected side. Furthermore, we compared leg length measurements between patients who did and who did not have a contralateral epiphysiodesis. RESULTS Overall, 79 patients were included, of whom 21 underwent contralateral epiphysiodesis for leg length correction. In the complete cohort, the mean LLD was 1.8 cm (95% confidence interval (CI) 1.5 to 2.0), mean ATD difference was 1.8 cm (95% CI -2.1 to -1.9), and mean subtrochanteric difference was -0.2 cm (95% CI -0.4 to 0.1). In the epiphysiodesis group, the mean LLD before epiphysiodesis was 2.7 cm (95% CI 1.3 to 3.4) and 1.3 cm (95% CI -0.5 to 3.8) at skeletal maturity. In the nonepiphysiodesis group the mean LLD was 2.0 cm (95% CI 0.5 to 5.1; p = 0.016). The subtrochanteric region on the PD side was significantly longer at skeletal maturity in the epiphysiodesis group compared to the nonepiphysiodesis group (-1.0 cm (95% CI -2.4 to 0.6) vs 0.1 cm (95% CI -1.0 to 2.1); p < 0.001). CONCLUSION This study demonstrates that LLD after PD originates from the proximal segment only. In patients who had contralateral epiphysiodesis to balance leg length, this is achieved by creating a difference in subtrochanteric length. Arthroplasty surgeons need to be aware that shortening of the proximal femur segment in PD patients may be misleading, as the ipsilateral subtrochanteric length in these patients can be longer. Therefore, we strongly advise long-leg standing films for THA planning in PD patients in order to avoid inadvertently lengthening the limb. Cite this article: Bone Joint J 2021;103-B(11):1736-1741.
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Affiliation(s)
- Jaap J Tolk
- Catterall Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK.,Orthopaedics and Sports Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Deborah M Eastwood
- Catterall Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK.,Orthopaedic Surgery, Great Ormond Street Hospital, London, UK.,University College London, London, UK
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Sansanovicz D, Croci AT, Vicente JRN, Ejnisman L, Miyahara HDS, Gurgel HDMC. Artroplastia total do quadril não cimentada em pacientes com osteoartrose secundária à doença de Legg-Calvé-Perthes em comparação com a osteoartrose primária: Um estudo caso-controle. Rev Bras Ortop 2021; 57:843-850. [PMID: 36226203 PMCID: PMC9550378 DOI: 10.1055/s-0041-1732330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022] Open
Abstract
Objective
To perform a comparative clinical, functional and radiographic evaluation of total hip arthroplasty (THA) performed with a cementless prosthesis in cases of osteoarthrosis secondary to Legg-Calvé-Perthes Disease (LCPD) and in cases of primary osteoarthrosis.
Methods
In the present case-control study, we reviewed medical records of patients admitted to a university hospital between 2008 and 2015 to undergo THA due to LCPD sequelae and compared them with a control group of patients who underwent the same surgery due to primary hip osteoarthrosis. We recruited patients for clinical, functional, and radiographic analysis and we compared the evaluations in the immediate postoperative period and at the last follow-up visit, considering surgical time, size of prosthetic components, and complications.
Results
We compared 22 patients in the study group (25 hips) with 22 patients (25 hips) in the control group, all of whom had undergone THA with the same cementless prosthesis. There was greater functional impairment in the group of patients with LCPD sequelae (
p
= 0.002). There were 4 intraoperative femoral periprosthetic fractures in the LCPD group and none in the primary osteoarthrosis group (
p
= 0.050).
Conclusions
There is an increased risk of intraoperative periprosthetic femoral fracture and worse clinical-functional results in patients undergoing cementless THA due to osteoarthrosis secondary to LCPD sequelae than in those who have undergone the same surgery due to primary hip osteoarthrosis.
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Affiliation(s)
- Dennis Sansanovicz
- Disciplina de Ortopedia e Traumatologia, Faculdade de Medicina da Universidade de Santo Amaro, Universidade de Santo Amaro, São Paulo, SP, Brasil
| | - Alberto Tesconi Croci
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - José Ricardo Negreiros Vicente
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Leandro Ejnisman
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Helder de Souza Miyahara
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Henrique de Melo Campos Gurgel
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Anthony CA, Wasko MK, Pashos GE, Barrack RL, Nunley RM, Clohisy JC. Total Hip Arthroplasty in Patients With Osteoarthritis Associated With Legg-Calve-Perthes Disease: Perioperative Complications and Patient-Reported Outcomes. J Arthroplasty 2021; 36:2518-2522. [PMID: 33674165 DOI: 10.1016/j.arth.2021.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Complications and patient-reported outcomes (PROs) of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) have demonstrated variable results. The purpose of this study was to use a validated grading scheme to analyze complications associated with THA in patients with residual LCPD deformities. Second, we report PROs and intermediate-term survivorship in this patient population. METHODS A retrospective, single-center review was performed on 61 hips in 61 patients who underwent THA for residual Perthes disease. Average patient age was 42 years and 26% of hips had previous surgery. Complications were determined and categorized using a validated grading scheme that included five grades based on the treatment required to manage the complication and on persistent disability. PROs were compared from preoperative to most recent follow-up time points. RESULTS Major complications (grade III) occurred in three patients (5%) which each required a second surgical intervention. The most common minor grade I or II complications (11.5%) were asymptomatic heterotopic ossification (3.3%). Patients were lengthened on the surgical side an average of 1.4 cm with no nerve palsies. All patient PROs improved from preoperative to postoperative time points with the modified Harris Hip Score improving from 46.9 preoperatively to 85.4 postoperatively (P < .01). Patients free from revision for any reason at final follow-up (5.6 years; range 2-13 years) was 98.4% with one patient needing a revision of their femoral component. CONCLUSIONS THA for the sequelae of the LCPD has an acceptable complication rate and provides excellent patient reported outcomes at mid-term follow-up.
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Affiliation(s)
- Chris A Anthony
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA; Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Marcin K Wasko
- Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
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Takahashi E, Kaneuji A, Florissi I, Bragdon CR, Malchau H, Kawahara N. Satisfactory Outcomes in Patients Operated With Primary Total Hip Arthroplasty for Perthes-like Deformities: Results From a Surgical Technique Utilizing a Conical Stem, an Elevated Hip Center, and No Shortening Femoral Osteotomy. Arthroplast Today 2020; 7:29-36. [PMID: 33521194 PMCID: PMC7818598 DOI: 10.1016/j.artd.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/01/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Total hip arthroplasty (THA) performed on patients with Perthes-like deformities are technically challenging because of the patient's abnormal hip anatomy. Patients with Perthes-like deformities are at a higher risk of revision, aseptic loosening, nerve injury, and intraoperative fracture after THA, especially if shortening osteotomies are performed. This analysis sought to examine the clinical and radiographic outcomes of a patient cohort with Perthes-like deformities receiving THA with a conical stem, an elevated hip center, and no shortening femoral osteotomy. Methods Twenty-six patients (27 hips) received THA with MODULUS femoral stems, ceramic or metal femoral heads, and highly cross-linked polyethylene liners between April 2011 and March 2016. All patients were treated at a single center by 4 participating surgeons. Patients completed 2 questionnaires preoperatively and at the final follow-up visit (between 1 and 5 years postoperatively): Harris Hip Score and Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire. Differences in patient-reported outcome measures (PROM) scores were measured by paired t-tests. Preoperative and postoperative anteroposterior radiographs were analyzed to monitor patient outcomes. Results Significant clinical improvements were observed in all individual subcategories of the Harris Hip Score and of the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire; the largest magnitude improvements were observed in the subcategory of pain relief for both questionnaires. No complications, including intraoperative and postoperative femoral fractures, nerve palsy, dislocations, or deep venous thrombosis, were observed. Conclusion This study found that patients treated with an elevated hip center and low stem-positioning technique using a conical, modular implant system had good clinical outcomes and did not suffer complications at the mean follow-up from surgery of 2.8 years (range: 1-5 years).
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Affiliation(s)
- Eiji Takahashi
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Corresponding author. Daigaku 1-1, Uchinada-Machi, Kahoku-Gun, Ishikawa 920-0293, Japan. Tel.: +81 76 218 8000.
| | - Ayumi Kaneuji
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
| | - Isabella Florissi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Charles R. Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedics, Sahlgrenska University Hospital, Mo¨lndal, Sweden
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
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Su EP, Morgenstern R, Khan I, Gaillard MD, Gross TP. Hip resurfacing arthroplasty for end-stage arthritis caused by childhood hip disease. Hip Int 2020; 30:572-580. [PMID: 31232105 DOI: 10.1177/1120700019858728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Patients with hip arthritis due to Legg-Calvé-Perthes (LCP) and slipped capital femoral epiphysis (SCFE) pose altered femoral anatomy, making hip resurfacing arthroplasty (HRA) technically complicated. We examined implant survival and clinical symptoms in patients with a history of LCP or SCPE who underwent HRA for end-stage osteoarthritis. METHODS Data was collected for patients who underwent HRA for osteoarthritis due to LCP (n = 59) or SCFE (n = 32). Harris Hip Scores (HHS), UCLA activity scores, and radiographs were evaluated pre and postoperatively. Wilcoxon Signed-Rank Tests and Kaplan-Meier Survivorship curves were used to analyse data. RESULTS Survivorship for freedom from revision or clinical failure was 93.55(95% CI, 78.47-98.18) at 5.79 years, up until the most recent follow-up of 11.23 years. There were 3 failures: 1 LCP due to instability at 2.4 years, 1 SCFE due to femoral neck fracture at 1 month, and another SCFE due to unexplained pain at 5.8 years. Five patients, 1 LCP and 4 SCFE, had retained hardware prior to surgery; 4 had their hardware removed during surgery. Postoperatively HHS and UCLA activity scores increased (p < 0.0001, for both measures). Leg-length discrepancy improved preoperatively from 7.9 (0.0-32) mm to 0.65 (0.0-10) mm postoperatively (p < 0.0001). Follow-up radiographs of all non-failure HRA patients revealed implants to be in good alignment with no indication of loosening. CONCLUSION Although HRA in SCFE and LCP patients increases technical difficulties, findings demonstrate excellent implant survival, no intraoperative complications, and improvements in leg-length discrepancies and clinical functional outcomes.
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Affiliation(s)
- Edwin P Su
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Rachelle Morgenstern
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Imraan Khan
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
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Matsubayashi S, Chiba K, Tsujimoto R, Osaki M, Wada A. Femoral osteotomy to improve range of motion in residual deformity of perthes disease: A case report. Ann Med Surg (Lond) 2020; 55:5-8. [PMID: 32435473 PMCID: PMC7229284 DOI: 10.1016/j.amsu.2020.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The treatment strategies for residual deformity of Perthes disease are not established. CASE PRESENTATION This is a case report of a 15-year-old boy. He developed right Perthes disease (lateral pillar classification group B) when he was 10 years old and underwent varus femoral osteotomy of the right side. At 12 years of age, he developed left Perthes disease (lateral pillar classification group B) and underwent varus femoral osteotomy of the left side. Postoperatively, he was treated with partial weight bearing of the left leg with crutches. At 15 years, range of motion (ROM) of his left hip was markedly limited at 30° flexion, 10° abduction, 70° external rotation, and -20° internal rotation, and he was having difficulty maintaining a sitting position. DIAGNOSIS Stulberg group V was noted on plain radiography. Computed tomography (CT) showed collapse of the load-bearing part of the femoral head on the coronal plane, but the ball-shape was maintained in the posterior femoral head on sagittal and transverse sections. INTERVENSINOS Valgus-flexion-internal rotation osteotomy was performed to improve ROM. OUTCOMES Left hip ROM improved to 90° flexion, 20° abduction, 50° external rotation, and 40° internal rotation immediately after the surgery. He was able to sit 10 months postoperatively but was left with a limp and limited ROM in the left hip at 60° flexion. Chondroplasty was performed during the plate removal surgery at 10 months postoperatively, which improved hip flexion to 100° immediately after the surgery. The patient was left with limited ROM of 60° flexion of the left hip at the final observation. CONCLUSION Femoral osteotomy to improve ROM could be an option for residual deformity of Perthes disease.
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Affiliation(s)
- Shohei Matsubayashi
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Ko Chiba
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Ritsu Tsujimoto
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Akifusa Wada
- Department of Orthopaedic Surgery, Saga Handicapped Children's Hospital, Japan
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Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN. Does Surgeon Volume Affect Outcomes Following Primary Total Hip Arthroplasty? A Systematic Review. J Arthroplasty 2018; 33:3329-3342. [PMID: 29921502 DOI: 10.1016/j.arth.2018.05.040] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/06/2018] [Accepted: 05/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgeon volume has been identified as an important factor impacting postoperative outcome in patients undergoing orthopedic surgeries. With an absence of a detailed systematic review, we sought to collate evidence on the impact of surgeon volume on postoperative outcomes in patients undergoing primary total hip arthroplasty. METHODS PubMed (MEDLINE) and Google Scholar databases were queried for articles using the following search criteria: ("Surgeon Volume" OR "Provider Volume" OR "Volume Outcome") AND ("THA" OR "Total hip replacement" OR "THR" OR "Total hip arthroplasty"). Studies investigating total hip arthroplasty being performed for malignancy or hip fractures were excluded from the review. Twenty-eight studies were included in the final review. All studies underwent a quality appraisal using the GRADE tool. The systematic review was performed in accordance with the PRISMA guidelines. RESULTS Increasing surgeon volume was associated with a shorter length of stay, lower costs, and lower dislocation rates. Studies showed a significant association between an increasing surgeon volume and higher odds of early-term and midterm survivorship, but not long-term survivorships. Although complications were reported and recorded differently in studies, there was a general trend toward a lower postoperative morbidity with regard to complications following surgeries by a high-volume surgeon. CONCLUSION This systematic review shows evidence of a trend toward better postoperative outcomes with high-volume surgeons. Future prospective studies are needed to better determine long-term postoperative outcomes such as survivorship before healthcare policies such as regionalization and/or equal-access healthcare systems can be considered.
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Affiliation(s)
- Azeem T Malik
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Nikhil Jain
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Thomas J Scharschmidt
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Mengnai Li
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Andrew H Glassman
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Safdar N Khan
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, OH
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Imageless Navigation Improves Intraoperative Monitoring of Leg Length Changes during Total Hip Arthroplasty for Legg-Calve-Perthes Disease: Two Case Reports. Case Rep Orthop 2018; 2018:4362367. [PMID: 30123597 PMCID: PMC6079508 DOI: 10.1155/2018/4362367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/14/2018] [Indexed: 11/22/2022] Open
Abstract
Legg-Calve-Perthes disease is a rare condition characterized by avascular necrosis and malformation of the femoral head. For many patients, total hip arthroplasty (THA) is the only viable treatment option; however, there are challenges associated with THA in this population, primarily the equalization of leg lengths. Here, we present two cases of Legg-Calve-Perthes disease treated via total hip arthroplasty with the assistance of an imageless, computer-assisted navigation device. In each case, the device provided intraoperative data on leg length in real time, allowing for improved accuracy of component placement. Postoperative leg lengths were confirmed to be equalized in each case using radiographs. These cases are, to our knowledge, the first such cases using imageless navigation during THA and demonstrate the benefits of such assistive technologies in challenging cases such as Legg-Calve-Perthes disease.
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