Clinico-Radiological Evaluation of Perthes Disease Patients Treated by Shelf Acetabuloplasty
Introduction: The most important prognostic factors of Perthes disease are age of onset and lateral extrusion of the femoral head. Shelf acetabuloplasty can be used as a containment procedure in early stages and as a salvage procedure in the late stages of Perthes disease. Shelf procedure in growing age will act as labral support procedure and will stimulate growth of lateral acetabular epiphysis. The purpose of the study was to evaluate the functional and radiological outcome of patients treated by shelf acetabuloplasty and to assess the percentage resorption of iliac graft with time.
Materials and Methods: It was a prospective cohort study with 22 patients. Patients were followed up at 6 months, 9 months, 1 year and 2 years. Functional assessment using Harris hip score was done pre operatively and at each follow up while radiological outcome was assessed by the percentage of femoral head coverage and Stulberg classification at 2 years.
Results: The extra-osseous portion of the shelf initially was 15 mm which showed a significant decrease in length (11.7 mm) at 2 year follow up. The femoral head cover at final follow up significantly increased to 100.1% from the initial 81.3%. The addition of shelf decreased the acetabular angle to 37.6? from 48? preop. Satisfactory radiological outcome according to Stulberg classification were obtained in 17 cases, while 5 cases had unsatisfactory results. 3 out of 22 had excellent functional outcome while the rest had good outcome.
Conclusion: Shelf acetabuloplasty fulfills the principles of Perthes disease management by correcting the lateral subluxation and containment of the femoral head. Shelf acetabuloplasty definitely improves the functional and radiological outcome of late onset Perthes disease patients.