Predictors of radiographic outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease

Stančák, Andrej; Kautzner, Jakub; Chládek, P; Adamec, Ondřej; Havlas, Vojtěch; Trč, Tomáš

doi:10.1007/s00264-022-05584-x

Cited by 3 publications

(6 citation statements)

References 34 publications

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“…Therefore, it is not recommended to use this measuring method in these patients. Andrej 24 included both surgical and conservative treated patients in one study. He believes that the treatment of LCPD is not related to the choice of treatment method, but to the age of patients, and the treatment effect of children under 6 years old in his study was better than that of children over 6 years old.…”

Section: Discussionmentioning

confidence: 99%

Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

Zhao,

Fan,

Guan

et al. 2024

Preprint

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Early treatment of Legg-Calve´-Perthes disease (LCPD)can improve hip joint activity and life management in adulthood. However, the current classification of LCPD is based on imaging findings in the fragmented stage of the disease, which is prone to delay treatment. Therefore the aim of this study is to evaluate the potential risk factors associated with poor radiological outcomes of LCPD, and to develop a new index for hip consistency evaluation, which can be used to speculate radiographic outcomes at the time of the first visit. The acetabular-femoral head match index (AFMI) of each enrolled subject was measured in standard anterior-posterior radiograph images. In the study of patients presenting during necrosis and fragmentation stage, a significant correlation was established between AFMI and modified Stulberg classification (P<0.05). The results of binary logistic regression analyses showed that Herring classification of fragmentation stage and AFMI were the main risk factors for flat hips. Thus, we provide evidence suggesting that AFMI has a potential role in predicting patients who do not respond well to conservative treatment. Although prospective multicenter studies are needed, these results provide useful clinical clues for the early treatment of LCPD.

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Section: Discussionmentioning

confidence: 99%

Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

Zhao,

Fan,

Guan

et al. 2024

Preprint

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“…Maturity, using chronologic age at presentation as a proxy, is one factor, which has been shown to influence patient outcomes with older patients demonstrating worse outcomes at the time of skeletal maturity. [1][2][3] In this study, we investigated the utility of the optimized Oxford system as a means of assessing current skeletal age at the time of presentation in a known cohort of children with LCPD. Our results indicated significant variability between the optimized Oxford system and the GP maturity atlas with the optimized Oxford closely mirroring chronologic age, demonstrating a 1.7-year older bone age than the GP atlas, Figure 3.…”

Section: Discussionmentioning

confidence: 99%

“…LCPD is a challenging condition, which continues to remain an elusive entity for the treating pediatric orthopaedic surgeon. Maturity, using chronologic age at presentation as a proxy, is one factor, which has been shown to influence patient outcomes with older patients demonstrating worse outcomes at the time of skeletal maturity 1–3. In this study, we investigated the utility of the optimized Oxford system as a means of assessing current skeletal age at the time of presentation in a known cohort of children with LCPD.…”

Section: Discussionmentioning

confidence: 99%

“…Legg-Calve-Perthes Disease (LCPD) remains an elusive condition for the practicing pediatric orthopaedic surgeon. Although the etiology remains largely unknown, previous studies have demonstrated that immaturity at the time of disease onset is one factor associated with improved femoral head shape and functional outcomes at skeletal maturity 1–3. Herring et al1 reported that children 8 years and younger had superior outcomes compared with children older than 8 years at the time of presentation.…”

mentioning

confidence: 99%

“…Although the etiology remains largely unknown, previous studies have demonstrated that immaturity at the time of disease onset is one factor associated with improved femoral head shape and functional outcomes at skeletal maturity. [1][2][3] Herring et al 1 reported that children 8 years and younger had superior outcomes compared with children older than 8 years at the time of presentation. Subsequent studies have suggested that the optimal age for a favorable outcome at maturity is 6 years or younger at presentation.…”

mentioning

confidence: 99%

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Skeletal Maturity in Legg-Calve-Perthes Disease: Significant Discrepancy Present Between the Hand and the Hip

Shaw

Herring

2023

Journal of Pediatric Orthopaedics

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Background: The concept of delayed skeletal maturity in Legg-Calve-Perthes Disease (LCPD) has been well identified with the Greulich and Pyle (GP) atlas showing 1 to 2 years delay. Recently the optimized Oxford hip skeletal age (Optimized Oxford) system has been developed and shown to have similar accuracy as the GP atlas for assessing skeletal maturity. However, this system has not been used to assess skeletal maturity in LCPD. Methods: A retrospective review of a prospective, multicenter study of patients with LCPD treated from 1984 to 1991 and followed to skeletal maturity was performed. We identified all patients who had a left-hand radiograph at the time of presentation with an accompanying anteroposterior pelvis radiograph including the contralateral hip. Patients were excluded if their age at presentation fell outside the validated range for the Optimized Oxford system. GP atlas was used to determine bone age using left-hand radiographs and the nonaffected hip radiographs were used to calculate the Optimized Oxford bone age. Skeletal maturity indices were compared with chronological age (CA) to determine the discrepancy between methodologies. Results: A total of 71 patients met inclusion criteria (mean 9.5 ± 1.2 y at presentation, 42.2% females). The mean GP bone age was 1.4 years younger than CA (95% CI: 1.01-1.76 y), with the discrepancy being greater for boys than girls (1.8 vs 0.86 y, P = 0.02). The mean Optimized Oxford bone age was 0.31 years older than CA (95% CI: 0.24-0.38 y) and correlated significantly with CA (R = 0.97, P < 0.001). There were no sex differences in the Optimized Oxford bone age relative to CA (P = 0.32). The GP bone age was a mean of 1.7 years younger than the Optimized Oxford bone age (95% CI: 1.35-2.05 y). Conclusion: Skeletal maturity assessment in children with LCPD varies according to the utilized maturity system. The Optimized Oxford bone age more closely mirrors the patient's CA and does not correlate with the GP bone age, which reveals a delayed maturation.

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Incidence of total hip arthroplasty in patients with Legg-Calve-Perthes disease after conservative or surgical treatment: a meta-analysis

Zhi

Xiang

et al. 2023

International Orthopaedics (SICOT)

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Predictors of radiographic outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease

Cited by 3 publications

References 34 publications

Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

Legg-Calve´-Perthes disease - diagnostic value of acetabular-femoral head match index

Skeletal Maturity in Legg-Calve-Perthes Disease: Significant Discrepancy Present Between the Hand and the Hip

Incidence of total hip arthroplasty in patients with Legg-Calve-Perthes disease after conservative or surgical treatment: a meta-analysis

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