Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review

Abstract

Background Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

Mid–Long-Term Outcomes of Surgical Treatment of Legg-Calvè-Perthes Disease: A Systematic Review

“…In patients 6 to 8 years of age, the prognosis is variable and depends on the severity of the disease. Patients under 6 years of age have an excellent prognosis comparable to conservative treatment [ 45 ].…”

“…The combination of Salter’s innominate osteotomy and femoral varus osteotomy is used when only one of these procedures is insufficient to cover the femoral head within the acetabulum. The principal indications for using these techniques are late clinical onset, severe femoral head involvement, evidence of lateral subluxation, lateral calcification, or considerable changes in the metaphysis [ 45 , 46 , 47 ].…”

Operative Management of Avascular Necrosis of the Femoral Head in Skeletally Immature Patients: A Systematic Review

“…Given the lack of quantitative data, bilaterality of ONFH it was not possible to investigate separately. Finally, articles concern-Life 2022, 12, 179 9 of 12 ing Perthes disease have been excluded, as the management of these patients has been extensively analysed in the literature [70][71][72][73][74][75][76][77][78][79][80][81][82], and evidence on non-Perthes related ONFH is limited. Two studies which have been included for analysis reported data on patients with Perthes disease [31,33]; however, since the authors reported the results separately, data from patients with Perthes disease were not considered.…”

Perthes Disease in a Child With Osteogenesis Imperfecta From a Rare Genetic Variant: A Case Report

“…Presentation of Perthes disease has been reported in certain patients with increased susceptibility (Maleki et al, 2021;Miyamoto et al, 2017). Genetic mutation of COL2A1 has been reported to be involved in the genesis of a type II collagenopathy and a possible cause of LCPD (Kannu et al, 2011;Li et al, 2014).…”