Theoretical study of subluxation in early Legg-Calvé-Perthes disease

George T Rab

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

The relationship between mechanical subluxation and femoral head necrosis geometry in Legg-Calvé-Perthes disease (LCP) was investigated with a three-dimensional rigid body-spring method hip model. Femoral head models with progressively larger regions of necrosis, corresponding to the four Catterall grades, were placed in a spherical acetabular model and studied in static single-limb stance configuration, with variable mechanical rigidity of the necrotic segment. The degree of subluxation was dependent on the geometric region of involvement, mechanical properties of the segment, and direction of loading force. In general, femoral head subluxation was always in the direction of the necrosis, modified by the anatomic and force environment. In the neutral position, the Catterall I models exhibited minimal subluxation. The Catterall II model subluxated anteriorly as collapse occurred, and the Catterall III model subluxated anteriorly and superiorly. Lateral subluxation could be produced by changing the loading force to a more vertical orientation. The Catterall IV model collapsed directly along the line of force application rather than subluxating. Reorientation of models with minor necrosis could improve stability, but reorientation of models with extensive necrosis had minimal effect on subluxation behavior. Higher-grade LCP involvement may lead to early subluxation, particularly anteriorly, which is difficult to visualize radiographically. The appearance of lateral subluxation may signal a change in the mechanical environment of the hip from clinical progression of the disease. Femoral head reorientation (osteotomy) may improve femoral head stability when necrosis is limited but is unlikely to reduce subluxation or collapse when extensive necrosis is present.

Original languageEnglish (US)
Pages (from-to)728-733
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume25
Issue number6
DOIs
StatePublished - Nov 2005

Fingerprint

Legg-Calve-Perthes Disease
Theoretical Models
Necrosis
Thigh
Hip
Osteotomy
Disease Progression
Extremities

Keywords

  • Avascular necrosis
  • Legg-Calvé-Perthes disease
  • Rigid body-spring method
  • Subluxation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Theoretical study of subluxation in early Legg-Calvé-Perthes disease. / Rab, George T.

In: Journal of Pediatric Orthopaedics, Vol. 25, No. 6, 11.2005, p. 728-733.

Research output: Contribution to journalArticle

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