Ellipsoidal Process of the Femoral Head in Legg–Calvé–Perthes Disease: Effect of Prophylactic Hemiepiphysiodesis

Abril, Juan Carlos; Montero, Margarita; Fraga, Manuel; Egea-Gámez, Rosa M.

doi:10.1007/s43465-022-00662-z

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…Selective hemiepiphysiodesis of the healthy physis in the posteroinferior quadrant of the capital femoral epiphysis with a 3.2-mm cannulated drill bit has shown to suppress an ellipsoidal process of the femoral head in cases with physeal angulation during the reossification stage. 21 Another experimental investigation demonstrated that multiple epiphyseal drilling with a 2-mm smooth K-wire stimulated bone healing without a significant growth disturbance in a piglet model of ischemic osteonecrosis. 22 Taken together, the combined use of hemiepiphysiodesis of the posterior physis and multiple epiphyseal drilling focusing on the anterior curved physis might have a potent synergistic effect on the restitution of a greater spherical femoral head in the type D hips.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg–Calvé–Perthes disease

Mishima

Kamiya

Matsushita

et al. 2023

Journal of Children's Orthopaedics

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Purpose: To examine whether differences in bone resorption patterns in the anterior portion of the femoral head correlate with the prognosis of Legg–Calvé–Perthes disease. Methods: Seventy-eight patients with unilateral Legg–Calvé–Perthes disease, who were diagnosed after 6.0 years of age, underwent the Salter innominate osteotomy from 1987 to 2013, and were followed up to skeletal maturity. The anterior bone resorption pattern of the femoral head was evaluated from a frog-leg lateral hip radiograph made in the middle of the fragmentation period, and classified into two types, an epiphysis-preserved type (P) and a physis-disrupted type (D). The correlation between the type of bone resorption and the Stulberg outcome was analyzed. Results: The Stulberg outcomes were grade I for 10 patients, grade II for 31, grade III for 32, and grade IV for 5, with a mean follow-up period of 8.3 ± 2.7 years. Fifty-one patients demonstrated the type P hips and 27 did the type D hip. In a subset analysis of patients with the modified lateral pillar group-B hips in the younger group (6.0–8.9 years of age at diagnosis), the percentages of the favorable and unfavorable outcomes significantly differed between the two types ( p = 0.013). Anteroposterior enlargement of the affected femoral head was significantly greater in the type D hips than the type P hips ( p = 0.014). Conclusion: Unfavorable hip morphology at skeletal maturity can be predicted in patients with the lateral pillar group-B hips by focusing on bone resorption patterns of the anterior portion of the femoral head. Level of evidence: Level III, prognostic study.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg–Calvé–Perthes disease

Mishima

Kamiya

Matsushita

et al. 2023

Journal of Children's Orthopaedics

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“…Legg-Calve´-Perthes disease (LCPD) is a self-limiting disease, characterized by osteochondral necrosis of the femoral head, spherical appearance changes and upward movement of the greater trochanter [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

Zhao,

Fan,

Guan

et al. 2024

Preprint

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Early treatment of Legg-Calve´-Perthes disease (LCPD)can improve hip joint activity and life management in adulthood. However, the current classification of LCPD is based on imaging findings in the fragmented stage of the disease, which is prone to delay treatment. Therefore the aim of this study is to evaluate the potential risk factors associated with poor radiological outcomes of LCPD, and to develop a new index for hip consistency evaluation, which can be used to speculate radiographic outcomes at the time of the first visit. The acetabular-femoral head match index (AFMI) of each enrolled subject was measured in standard anterior-posterior radiograph images. In the study of patients presenting during necrosis and fragmentation stage, a significant correlation was established between AFMI and modified Stulberg classification (P<0.05). The results of binary logistic regression analyses showed that Herring classification of fragmentation stage and AFMI were the main risk factors for flat hips. Thus, we provide evidence suggesting that AFMI has a potential role in predicting patients who do not respond well to conservative treatment. Although prospective multicenter studies are needed, these results provide useful clinical clues for the early treatment of LCPD.

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Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

Zhao,

Fan,

Guan

et al. 2024

Sci Rep

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Early treatment of Legg-Calve´-Perthes disease (LCPD)can improve hip joint activity and life management in adulthood. However, the current classification of LCPD is based on imaging findings in the fragmented stage of the disease, which is prone to delay treatment. Therefore the aim of this study is to evaluate the potential risk factors associated with poor radiological outcomes of LCPD, and to develop a new index for hip consistency evaluation, which can be used to speculate radiographic outcomes at the time of the first visit. The acetabular-femoral head match index (AFMI) of each enrolled subject was measured in standard anterior-posterior radiograph images. In the study of patients presenting during necrosis and fragmentation stage, a significant correlation was established between AFMI and modified Stulberg classification ( P <0.05). The results of binary logistic regression analyses showed that Herring classification of fragmentation stage and AFMI were the main risk factors for flat hips. Thus, we provide evidence suggesting that AFMI has a potential role in predicting patients who do not respond well to conservative treatment. Although prospective multicenter studies are needed, these results provide useful clinical clues for the early treatment of LCPD.

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Ellipsoidal Process of the Femoral Head in Legg–Calvé–Perthes Disease: Effect of Prophylactic Hemiepiphysiodesis

Cited by 3 publications

References 28 publications

Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg–Calvé–Perthes disease

Prognostic value of bone resorption pattern in the anterior portion of the femoral head in Legg–Calvé–Perthes disease

Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

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