Natural History of Early Onset and Late-Onset Legg-Calve-Perthes Disease

Joseph, Benjamin

doi:10.1097/bpo.0b013e318223b423

Cited by 41 publications

(45 citation statements)

References 34 publications

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“…The average age of the included patients in our study was nearly 13 years old. In this age group, patients with bone necrosis lack satisfactory repair and remodelling abilities and show completely different natural histories and pathological processes than younger patients [25,26]. Spontaneous femoral head repair and remodelling into a spherical shape were never observed in our patients at the collapsed stage.…”

Section: Femur Head Necrosis In the Paediatric Population Can Be Indumentioning

confidence: 58%

The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

Yang

Hong

et al. 2020

Preprint

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Background: The natural history of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the natural history in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration. Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor natural history characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

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Section: Femur Head Necrosis In the Paediatric Population Can Be Indumentioning

confidence: 58%

The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

Yang

Hong

et al. 2020

Preprint

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“…It can require 2 to 4 years to heal [15] and this is related to remaining growth, which is limited in these patients. The long healing process results in an increased risk for femoral head collapse and deformity.…”

Section: Discussionmentioning

confidence: 99%

“…This results in the potential for femoral head collapse and deformity leading to advanced osteoarthritic changes within the hip. A major problem in older children and adolescents is the prolonged healing process over 2 to 4 years [15], which further enhances the development of femoral head deformity and subsequent osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis

Thompson

Lea

Chin

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression. Questions/purposes We investigated whether early MRI screening and CBGE prevented the development of advanced AVN changes in the CFE and the rates of complications with this approach. Methods We prospectively followed all 13 patients (seven boys, six girls) with unstable SCFEs (six patients), femoral neck fractures (five patients), and traumatic hip dislocations (two patients) and evidence of early AVN treated between 1984 and 2012. Mean age at initial injury was 12 years (range, 10-16 years). Nine of the 13 patients had followup of at least 2 years or until conversion to THA (mean, 4.5 years; range, 0.8-8.5 years), including two with unstable SCFEs, the five with femoral neck fractures, and the two with traumatic hip dislocations. All patients had technetium scans and/or MRI within 1 to 2 months of their initial injury (before CBGE) and all had evidence of early (Ficat 0) AVN. Patients were followed clinically and radiographically for AVN progression. Results Six of the nine hips did not develop typical clinical or radiographic evidence of AVN. These six patients have been followed 6.3 years (range, 4.3-9

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“…Some authors state that if it occurs in children >12 y old, its course is more similar to adult osteonecrosis than it is to Legg-Calve-Perthes disease. Juvenile osteonecrosis, although rare, has a higher incidence of long-term complications (44,45).…”

Section: Osteonecrosis Of the Femoral Headmentioning

confidence: 99%