Srpski arhiv za celokupno lekarstvo 2011 Volume 139, Issue 11-12, Pages: 834-837
https://doi.org/10.2298/SARH1112834V
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Femoroacetabular impingement related to Legg-Calvé-Perthes disease
Vukašinović Zoran (Institut za ortopedsko-hirurške bolesti „Banjica”, Beograd + Medicinski fakultet, Beograd)
Spasovski Duško (Institut za ortopedsko-hirurške bolesti „Banjica”, Beograd + Medicinski fakultet, Beograd)
Živković Zorica (Kliničko-bolnički centar „Dr Dragiša Mišović”, Beograd + Medicinska akademija US Medical School, Evropski univerzitet, Beograd)
Femoroacetabular impingement is an undesirable contact between acetabular rim
and femoral neck and presents abnormality of proximal femoral part and
acetabulum, as well. Two forms may appear: cam impingement and pincer
impingement. Femoroacetabular impingement related to Legg-Calvé-Perthes
disease may be caused by various reasons, as the consequence of the disease
itself, and as the consequence of its treatment. Coxa magna deformity (large
femoral head and neck) and coxa brevis deformity (shortened femoral neck) may
produce cam femoroacetabular impingement during hip flexion. After the
disease, the flattened femoral head (coxa plana) may persist. Chiari pelvic
osteotomy is the only treatment option for such femoral head deformity.
Acetabular labrum squeezed continuously between the femoral head and the
non-articular part of the cut iliac bone lead to cam femoroacetabular
impingement, as well. If Salter or triple pelvic osteotomy is used that may
cause a very large iatrogenic acetabular retroversion, we can also refer to
radial type pincer femoroacetabular impingement. Treatment of
Legg-Calvé-Perthes disease should be conducted according to the natural
course of the disease and prognosis. Treatment should start on time, well
before a crushed femoral head develops, because it is the easiest way to
establish hip spherical congruency at the end of treatment. This is the best
option to prevent secondary hip arthrosis caused by femoroacetabular
impingement or by insufficient head coverage at the end of remodelling. In
each case of delayed hip pain, followed by a limited range of movements,
femoroacetabular impingement should be taken into consideration, confirmed,
and treated by some of the available therapeutic methods.
Keywords: Legg-Calvé-Perthes disease, cam impingement, pincer impingement