Shelf acetabuloplasty in children diagnosed with osteonecrosis of the femoral head secondary to acute lymphoblastic leukaemia.
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BACKGROUND: Shelf acetabuloplasty (SA) is a pelvic augmentation procedure often described in treatment of children diagnosed with Perthes disease of hip. This retrospective study is the first to report outcome in osteonecrosis of the femoral head (ONFH) secondary to acute lymphoblastic leukaemia (ALL). PATIENT AND METHODS: All patients treated with SA in duration between 2017 and 2024 were included except for those who had follow-up less than one year following surgery. Patients selected for SA were those aged between 6 and 13-y with stage B or C collapse of the femoral head according to lateral pillar classification. The functional outcome was assessed pre-operative and at the latest follow-up using Harris Hip Score (HHS). The difference between both scores was compared using Wilcoxon Signed-Rank Test. Risk for advanced hip arthrosis was estimated based on Stulberg classification in radiograph done at latest follow-up. RESULTS: A total of 15 patients were included: 7 males and 8 females. Four patients had bilateral hip involvement, with a total of 19 hips for evaluation. The mean age was 9.6 ± 2.19-y (6-13) at time of surgery and 14.1±2.70-y (10.3-18.4) at latest follow-up. Fifteen hips (79%) were Lateral Pillar stage B, and 4 (21%) were Lateral Pillar stage C. The mean follow-up duration was 44.7±21.00 (16-72) m. The median pre-operative HHS was 74 % (25, 42-88) and median post-operative HHS was 96% (20, 54-100), with a p-value of 0.002. According to Stulberg classification, 10 hips (52.6%) were grade 1 and 2 with no risk of hip arthritis, 5 (26.3%) grade 3 with mild risk, and 4 (20%) grade 4 and 5 with a high risk. Complications were graft resorption in two and infection in one hip. CONCLUSION: S.A. may improve coverage of the femoral head and the functional outcome of ALL patients diagnosed with advanced stage of ONFH and may potentially reduce the risk for advanced hip osteoarthrosis. LEVEL OF EVIDENCE: Retrospective case series, level IV.