Legg-Calvé-Perthes disease. Long-term evaluation of non-containment treatment.

Kelly, Francis; Canale, S T; Jones, Robin

doi:10.2106/00004623-198062030-00009

Cited by 71 publications

(39 citation statements)

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“…To increase the prognostic accuracy he introduced the concept of head-at-risk signs. 2 Since then many authors have used this classification, [8][9][10][11][12][13][14][15][16] but there have been some criticisms. First, the grouping is based on the epiphyseal involvement at the time of maximum resorption.…”

Section: Discussionmentioning

confidence: 99%

“…This occurs relatively late and the grouping will appear to change if the classification is applied too early. 13,15,16 Secondly, there is a poor level of interobserver agreement 17,18 and groups 2 and 3 are particularly difficult to separate. Fulford et al 5 , in their prospective study, suggested that the final functional result could be predicted more accurately by the arthrographic appearances at initial examination rather than by the Catterall classification.…”

Section: Discussionmentioning

confidence: 99%

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Prognosis in Perthes’ disease

Ismail

Macnicol

1998

The Journal of Bone and Joint Surgery. British volume

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W e compared the prognostic value of the Catterall grouping, the Salter-Thompson grading, the arthrographic shape of the femoral head, and the Herring lateral pillar grouping during the fragmentation stage of Perthes' disease in 73 patients with 81 affected hips. Radiographs were available for study from the onset of the disease until skeletal maturity. We used the Stulberg classification to assess outcome.The Herring grade and arthrographic sphericity proved to be the best predictors of final outcome. Combining these two values further increased the predictive value. All but one patient in Herring group A achieved an excellent outcome. In Herring group B, the age of the child and the sphericity of the femoral head influenced the end result. If the child was less than seven years old at the onset of symptoms the prognosis was invariably good and all spherical hips in group B had a good outcome with Stulberg grades 1 or 2. Moderately and severely deformed hips on arthrography resulted in Stulberg 3 and 4 hips. None of the hips in Herring group C had a normal appearance at maturity and the outcome was not significantly influenced by the age at onset or the arthrographic appearance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognosis in Perthes’ disease

Ismail

Macnicol

1998

The Journal of Bone and Joint Surgery. British volume

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“…There was no patient submitted to arthroplasty up and load restraint, allowed irrespectively to disease's phase were included, with clinical treatment being recommended with rest in bed and traction, in severe limitations of the range of motion. Surgical treatment for restraint was indicated by the presence of signs of "head at risk" (8,9) . In group II, treatment was provided with load restraint during the active phase of the disease, necrosis and/or fragmentation, alternating periods of 6 weeks with plastered immobilization in abduction and inward rotation, followed by plaster removal for two or three weeks -intending a gain in the range of motion -but load was not allowed yet.…”

Section: Abstract: Legg-perthes Disease; Follow-up Studies; Treatmentmentioning

confidence: 99%

Análise a longo prazo do tratamento conservador na doença de Legg-Calvé-Perthes

Alves¹,

Santili

2005

Acta ortop. bras.

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O objetivo do estudo é a análise a longo prazo de pacientes portadores da doença de Legg-Calvé-Perthes que foram tratados conservadoramente. Foram analisados 43 pacientes (49 quadris), na fase ativa da doença, radiograficamente segundo os critérios de Catterall e Herring, na época do diagnóstico, e os métodos Mose e Stulberg, na maturidade esquelética, e clinicamente segundo os critérios de Larson, ou escala de IOWA. O tempo de seguimento médio foi de 19 anos. Os pacientes foram divididos em dois grupos: grupo I, onde a carga foi liberada e grupo II restrição da deambulação. Na análise dos resultados obtidos segundo a escala de IOWA, não houve diferença estatística significante entre os dois grupos. Dentre os métodos empregados na fase ativa da doença, a classificação radiográfica segundo os critérios de Herring et al. foi aparentemente a que maior concordância apresentou com os resultados observados na classificação de Stulberg et al. Os autores concluem que os resultados avaliados pela escala de IOWA não se correlacionam com a gravidade do acometimento da doença e nem com a avaliação radiográfica na maturidade esquelética.

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“…Earlier studies are retrospective without any control group. In addition, the treatments have been combinations of several treatments such as: bed rest [6, 12, 14-16, 18, 20], traction [5,12,15], abduction splints [15,18], plaster [15], spica casting with [2,5,6,10,16,18] and without [2,5,6] weightbearing, Thomas splint [20,21], shoe elevation on the normal side [16,20], crutches [10,16,20], wheelchair [10], or no treatment [2,21]. In contrast, we evaluated one treatment method, namely, use of a Thomas splint.…”

Section: Introductionmentioning

confidence: 99%

“…Earlier studies have shown an overall prevalence of OA between 5% and 100% [2,5,6,10,12,14,16,20,21], and a prevalence of THA ranging from 0% to 24% [2, 5, 6, 10, 12, 14-16, 18, 20, 21] ( Table 1).…”

Section: Introductionmentioning

confidence: 99%

The Need for Total Hip Arthroplasty in Perthes Disease: A Long-term Study

Froberg

Christensen

Pedersen

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Legg-Calvé-Perthes disease (LCPD) was described a century ago. In previous long-term reports of patients with LCPD, nonoperative treatment varied considerably. The likelihood of hip osteoarthritis (OA) developing in patients with LCPD and possible need for THA are not well defined. Questions/purposes The purpose of the study was to determine whether nonoperatively treated patients with LCPD (1) had an increased prevalence of THA compared with gender-and age-matched control subjects, (2) if patients with Stulberg Classes III/IV/V femoral heads had an increased risk of THA compared with those with Classes I/II femoral heads. Given the limitation in the study, we (3) evaluated whether patients with LCPD were at risk for having radiographic hip OA more commonly than control subjects and (4) whether hips with Classes III/ IV/V femoral heads had an increased prevalence of OA compared with hips with Classes I/II femoral heads. Patients and MethodsThe study population consisted of 167 patients with LCPD treated with a Thomas splint. The control population consisted of gender-and agematched control subjects who were participants in the Copenhagen City Heart Study: the Osteoarthritis Substudy. Radiographs at skeletal maturity were classified according to the classification system of Stulberg et al. Data from the Danish Hip Arthroplasty Register and the Registries of the National Board of Health were collected to obtain the number of patients with LCPD having THA. At a mean followup of 47 years later (range, 37-58 years), weightbearing pelvic radiographs were obtained. Radiographic OA was defined as a joint space width of 2.0 mm or less. Results Thirteen percent of patients with LCPD had THAs compared with none in the control group. Seven percent of the patients with LCPD had OA compared with 1% in the control group. The prevalence of THA and OA was increased in hips with Classes III/IV/V femoral heads compared with hips with Classes I/II femoral heads. Conclusions Patients with LCPD have an increased risk of having THA compared with a gender-and age-matched control group. Our data suggest that patients with LCPD have a greater risk of having radiographic OA develop than a gender-and age-matched control group. It seems that patients with Classes III/IV/V femoral heads have an increased risk of THA and OA compared with patients with Classes I/II femoral heads. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.One of the authors (LF) has received funding from the Research Board of Kolding Hospitals, Denmark. The funding did not play a role in the investigation. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research. This work was performed at

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Legg-Calvé-Perthes disease. Long-term evaluation of non-containment treatment.

Cited by 71 publications

References 0 publications

Prognosis in Perthes’ disease

Prognosis in Perthes’ disease

Análise a longo prazo do tratamento conservador na doença de Legg-Calvé-Perthes

The Need for Total Hip Arthroplasty in Perthes Disease: A Long-term Study

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