Shelf acetabuloplasty, percutaneus drilling of the femoral head and soft tissue release for treatment of late onset Legg Calve’ Perthes disease

Abstract

This finding challenges the concept of containment. Although both varus derotational osteotomy and innominate osteotomy increase lateral and anterior coverage throughout the gait cycle, this occurs at the expense of posterior coverage.The shelf procedure is an acetabuloplasty intended to promote eventual long term congruency between the uncovered femoral head and the opposing acetabulum. This procedure involves increasing the superolateral support or coverage of the femoral head by extending the acetabular roof . Those supporting the procedure argue addition of bone to the lateral rim supports the labrum in abduction and prevents subluxation and abutment of the femoral head against the superolateral margin of the acetabulum with opening of the medial joint space, so-called hinged abduction. The procedure is technically simple, safe, and effective in severe cases of LCP disease with major deformity and subluxation of the femoral head as well as joint incongruency and impingement . IT insures good and long-lasting femoral head coverage, allowing optimal remodeling of the hip joint .Those