Comparison of Lateral Shelf Acetabuloplasty in the Treatment of Legg-Calvé-Perthes Disease in Older Children

BACKGROUND: In older children with Perthes disease, where containment surgery is often indicated, the comparative effectiveness of the 2 principal shelf acetabuloplasty techniques, Staheli and Tectoplasty, remains unclear. METHODS: A total of 26 children (23 males and 3 females; mean age at surgery, 8.55±0.95 y) underwent the Staheli technique, and 20 children (18 males and 2 females; mean age at surgery, 8.65±0.89 y) were treated with the Tectoplasty technique. Clinical data and radiographs were retrospectively reviewed. Radiographic parameters, including the center-edge angle, Sharp angle, femoral head subluxation ratio, femoral head size ratio, and final Stulberg classification, were assessed. RESULTS: Femoral head containment improved significantly in both groups. The postoperative-to-preoperative CE angle ratio was greater in the Staheli group than in the Tectoplasty group (213.14±38.66% vs. 189.33±39.08%, P=0.04). The postoperative-to-preoperative Sharp angle ratio was comparable between groups (75.09±6.60% vs. 75.31±5.41%, P=0.90). The postoperative-to-preoperative subluxation ratio was lower in the Tectoplasty group than in the Staheli group (67.66±6.64% vs. 74.90±10.05%, P=0.008). The postoperative-to-preoperative femoral head size ratio was modestly greater in the Tectoplasty group than in the Staheli group (113.66±7.81% vs. 109.18±6.77%, P=0.04). No significant difference in the final Stulberg classification was found between groups (P=0.96). CONCLUSIONS: Both the Staheli and Tectoplasty techniques were associated with improved acetabular coverage and femoral head remodeling in older children with Legg-Calvé-Perthes disease. The Staheli technique showed a greater postoperative-to-preoperative CE angle ratio, whereas the Tectoplasty technique showed a lower postoperative-to-preoperative subluxation ratio. Sharp angle correction and final Stulberg classification were comparable between groups. These findings should be interpreted cautiously, given the retrospective Level III design and limited sample size. Further prospective studies are needed to confirm the comparative effectiveness and long-term outcomes of these 2 techniques. LEVEL OF EVIDENCE: Level III-retrospective comparative study.