Legg–Calvé–Perthes disease in patients under 5 years of age does not always result in a good outcome. Personal experience and meta-analysis of the literature

Fabry, Kristof; Fabry, Guy; Moens, Pierre

doi:10.1097/01202412-200305000-00011

Cited by 9 publications

(11 citation statements)

References 21 publications

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“…Snyder 38 found that 32% of patients aged five years or younger at onset and Catterall hips 3 or 4 had radiologically poor results. Likewise, Fabry, Fabry and Moens 39 reported 48% poor results according to a modified Stulberg classification, and Schoenecker, Stone and Capelli 40 reported that 24% of children under six years of age with hips in Catterall groups 3 or 4 had poor results. Our study did not support these findings, as the poor results in this group were only 12%, the same as those reported by Rosenfeld et al 30 As with some previous studies, [36][37][38][39][40][41] we found a significant association between the lateral pillar classification and radiological outcome.…”

Section: Discussionmentioning

confidence: 98%

Prognostic factors and outcome of treatment in Perthes’ disease

Wiig¹,

Terjesen

Svenningsen

2008

The Journal of Bone and Joint Surgery. British volume

184

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This nationwide prospective study was designed to determine prognostic factors and evaluate the outcome of different treatments of Perthes' disease. A total of 28 hospitals in Norway were instructed to report all new cases of Perthes' disease over a period of five years and 425 patients were reported and followed for five years. Of these, 368 with unilateral disease were included in the present study. The hips were classified radiologically according to a modified two-group Catterall classification and the lateral pillar classification. A total of 358 patients (97%) attended the five-year follow-up, when a modified three-group Stulberg classification was used as a radiological outcome measure. For patients over six years of age at diagnosis and with more than 50% necrosis of the femoral head (152 patients), the surgeons at the different hospitals had chosen one of three methods of treatment: physiotherapy (55 patients), the Scottish Rite abduction orthosis (26), and proximal femoral varus osteotomy (71). Of these hips, 146 (96%) were available for the five-year follow-up. The strongest predictor of outcome was femoral head involvement of more or less than 50% (odds ratio (OR) = 7.76, 95% confidence interval (CI) 2.82 to 21.37), followed by age at diagnosis (OR = 0.98, 95% CI 0.92 to 0.99) and the lateral pillar classification (OR = 0.62, 95% CI 0.40 to 0.98). In children over six years at diagnosis with more than 50% of femoral head necrosis, proximal femoral varus osteotomy gave a significantly better outcome than orthosis (p = 0.001) or physiotherapy (p = 0.001). There was no significant difference between the physiotherapy and orthosis groups (p = 0.36), and we found no difference in outcome after any of the treatments in children under six years (p = 0.73). We recommend proximal femoral varus osteotomy in children aged six years and over at the time of diagnosis with hips having more than 50% femoral head necrosis. The abduction orthosis should be abandoned in Perthes' disease.

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Section: Discussionmentioning

confidence: 98%

Prognostic factors and outcome of treatment in Perthes’ disease

Wiig¹,

Terjesen

Svenningsen

2008

The Journal of Bone and Joint Surgery. British volume

184

View full text Add to dashboard Cite

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“…Snyder (1975) found that no less than 32% of patients with age at onset 5 years or younger and Catterall hips 3 or 4 had radiographically poor results at healing. Likewise, Fabry et al (2003) reported 48% poor results according to a modified Stulberg classification and Schoenecker et al (1993) reported that 24% of children under 6 years of age with hips in Catterall groups 3 or 4 had poor results. Our study did not support these findings, as the poor results in this group were only 12%, which is in accordance with the 12% poor results reported by Rosenfeld et al (2007).…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…Most long-term studies conclude that the patient's age at diagnosis is a prognostic factor (Danielsson and Hernborg 1965, Ratliff 1967, Catterall 1971, Mose 1977, Kelly et al 1980, Stulberg et al 1981, Perpich et al 1983, McAndrew and Weinstein 1984, Ippolito et al1987, Ismail et al 1998 in the sense that the younger the child at the time of diagnosis, the better the outcome. However, studies with somewhat different experience have been published (Snyder 1975, Fabry 2003 where the outcome in younger children (< 5 years) was not uniformly good. Catterall (1971) found that girls had a worse prognosis than boys.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Perthes' disease in Norway

Wiig

2009

Acta Orthopaedica

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“…LCPD, with an incidence between 4 and 32 per 100, 000 population per year, can be complicated by AVN [10]. The prognosis of LCPD is more favourable in patients with early onset regardless of treatment, but exceptions remain common [11]. Predicting which child will need a salvage procedure remains a major challenge, but approximately 5% of the affected children will require a total hip arthroplasty (THA) [12].…”

Section: Introductionmentioning

confidence: 99%

Medium-term outcomes of total hip arthroplasty in juvenile patients

Luceri

Morelli

Sinicato³

et al. 2020

J Orthop Surg Res

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Background Juvenile hip osteoarthritis is often the end result of congenital conditions or acquired hip ailments occurred during the paediatric age. This study evaluated the middle term results of total hip arthroplasty for end-stage juvenile hip osteoarthritis. Materials and methods This is a retrospective analysis of prospectively collected data on a cohort of 10 consecutive patients (12 hips), aged between 14 and 20 at operation, who underwent cementless total hip arthroplasty for end-stage juvenile secondary hip osteoarthritis in two orthopaedic tertiary referral centres between 2009 and 2018. Results Juvenile hip osteoarthritis occurred as a consequence of developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis. All patients showed a significant improvement in Harris Hip Score (p < 0.01) at 3.3 years average follow-up (range 0.7–10.1 years). Conclusion The management of juvenile hip osteoarthritis following developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis is still challenging. Careful preoperative planning is essential to achieve good outcomes and improve the Harris Hip Score in these young patients. Total hip arthroplasty is a suitable option for end-stage secondary juvenile hip osteoarthritis, when proximal femoral osteotomies and conservative treatments fail to improve patients’ symptoms and quality of life. Level of evidence IV

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Legg–Calvé–Perthes disease in patients under 5 years of age does not always result in a good outcome. Personal experience and meta-analysis of the literature

Cited by 9 publications

References 21 publications

Prognostic factors and outcome of treatment in Perthes’ disease

Prognostic factors and outcome of treatment in Perthes’ disease

Perthes' disease in Norway

Medium-term outcomes of total hip arthroplasty in juvenile patients

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