Arthrogram in Legg-Calvé-Perthes Disease

Abstract

There is a consensus among researchers that the treatment for Legg-Calvé-Perthes disease, whether conservative or surgical, is always based on the concept of "containment," that is, maintaining the femoral head inside the acetabulum socket throughout the entire evolution of the disease. Thus, the size and shape of the proximal femoral epiphysis should be monitored during the evolution of the disease. Although diagnosis is carried out by conventional radiographies in many medical institutions, this examination does not give us this information. Therefore, it becomes necessary to resort to other examination techniques, such as pneumoarthrography and magnetic resonance imaging. In our institution, we noticed the importance of hip arthrography in Legg-Calvé-Perthes disease from a study carried out by Laredo in 1985 that classified the disease into 5 groups based on the form and size of the femoral head and its position in the labrum. According to this researcher, group III, which he called "hip at premature arthrographic risk," requires action and yields the best results. The researchers have the opinion that dynamic pneumoarthrography is the best method for establishing an ideal position for the femoral head in relation to the acetabulum when surgical treatment is indicated.

Comparison of the results from simple radiography, from before to after Salter osteotomy, in patients with Legg-Calvé-Perthes disease

“…Table 1 summarizes the demographic data and all the variables gathered, with their respective distributions, including: sex, skin color, side affected, preoperative classification 1 , 2 , 3 , 4 , 5 , 6 , 7 and postoperative classification (Stulberg). 17 …”

“…This indication is made in cases with extensive impairment and especially in cases with alterations to the shape and size of the femoral head that are shown by arthrographic assessment of the hip in accordance with the Laredo classification. 6 , 7 …”

“…The preoperative radiographs were classified in accordance with the following methods that have been described in the literature: (1) Waldenström, 1 as modified by Jonsäter 2 ; (2) Catterall 3 ; (3) Laredo 6 , 7 ; and (4) the lateral pillar method of Herring et al 5 The radiographs obtained after skeletal maturity had been reached were classified in accordance with the method of Stulberg et al 17 …”

“…Because the hips have a cartilaginous mold during the growth stage that is not visible on simple radiographs, Laredo 6 and Milani and Dobashi 7 demonstrated that arthrography would make it possible to detect alterations to the shape of the head and femoral extrusion before conventional radiographic examination would be able to recognize these features. These authors proposed an arthrographic classification composed of five groups.…”

Comparação entre resultados de radiografia simples, pré e pós‐osteotomia de Salter, em pacientes portadores da doença de Legg‐Calvé‐Perthes

“…Essa indicação se dá nos casos com comprometimento extenso e, principalmente, com alteraç ões da forma e do tamanho da cabeça femoral evidenciadas pela avaliação artrográfica do quadril segundo a classificação de Laredo. 6,7 Foram usados neste estudo os métodos de classificação mais difundidos na literatura. Procurou-se estabelecer qual deles poderia ter maior valor prognóstico no resultado final após o curso da doença.…”