Iliac Splitting and Expanding Shelf (ISES) Arthroplasty in LCPD
IH Choi, TJ Cho, CY Chung, WJ Yoo, YW Shin
Seoul National University Children's Hospital, Seoul, Korea

We introduce a modified technique of iliac splitting and expanding shelf (ISES) arthroplasty for severe LCPD, and report the intermediate outcomes. This procedure is a modification of previously reported tectoplasty of Saito (1986) and shelf arthroplasty of Catterall (1992). We detached only the sartorius and the indirect head of the rectus femoris, leaving the abductors intact. A superiorly hinged bony flap was raised from the lateral iliac wall just above the hip joint capsule. A corticocancellous bone plate was harvested from the inner table of the iliac wing, and was placed between the lateral hip joint capsule and the bony flap. The trianagular space between the split iliac wall and the bone plate was packed with autogenous cancellous bone chips and Osteosetâ. Repaired indirect head of the rectus femoris gave stability to the shelf. After 4 weeks in Petrie cast the hip was mobilized, and partial weight bearing started postoperative 6 weeks. Twenty one hips in 21 children older than 8 years presenting with early (18 hips) and late (reossification) (3 hips) LCPD were treated by ISES arthroplasty. All patients were followed up for more than 2 (2 to 8.5) years. There were significant functional and radiological improvements after operation. One patient needed secondary varus osteotomy to solve persistent subluxation. Poorest result occurred in a very obese child, presenting with early stage of Catterall IV at age 11.5 years. Our modified technique of the shelf arthroplasty, sparing the abductor mechanism, is a reliable and effective method to augment the superolateral coverage of the femoral head in severe LCPD.