Triple Innominate Osteotomy for Legg-Calve-Perthes Disease in Children: Does the Lateral Coverage Change With Time?

Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calv,-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement. We therefore asked (1) whether TIO contained the femoral head in Catterall Stages III and IV of LCPD; (2) whether the center-edge (CE) angle, acetabular roof arc angle (ARA), and Sharp's angle changed during the growing years; and (3) what percentage of patients had radiographic evidence of pincer impingement beyond a minimum followup of 3 years. We identified 19 children who had 20 TIOs performed for Catterall Stages III and IV LCPD. Two blinded observers assessed sequential radiographs. Each observer made two sets of readings more than 2 weeks apart. Femoral head extrusion index, CE angle of Wiberg, ARA, and Sharp's angle were measured. Minimum followup was 3 years to document continued acetabular growth (mean, 3.8 years; range, 3-7 years). All patients exhibited femoral head containment at last followup. Eleven of 20 hips demonstrated no radiographic evidence of pincer morphology beyond a minimum followup of 3 years (mean, 3.8 years). Patients with CE angle corrected to 44A degrees or less and an ARA of greater than -6A degrees after TIO did not demonstrate a pincer morphology at last followup. TIO resulted in femoral head containment in all cases. Lateral acetabular coverage changed during the growing years in all patients. Surgical correction beyond 44A degrees of CE angle and -6A degrees of ARA should be avoided to prevent pincer morphology later. Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.