Prognosis in Perthes' disease after noncontainment treatment

Yrjönen, Timo

doi:10.3109/17453679209154728

Cited by 36 publications

(19 citation statements)

References 14 publications

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“…The prevalence of THA was 13% in patients in the current study compared with 0% to 24% reported in previous studies [2,5,12,14,20]. The studies have mean followups ranging from 28 to 50 years, which might explain the difference (Table 1).…”

Section: Discussioncontrasting

confidence: 51%

“…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%

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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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Section: Discussioncontrasting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

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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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“…Catterall [6] advocated in 1971 the significance of these factors and this was confirmed in many other studies [2,7,3,4,5]. Lateral calcification and subluxation are both signs of deterioration of containment.…”

Section: Discussionmentioning

confidence: 82%

“…One of them is age [1,2,3,4,5]. Most authors agree that the younger the patients are at the onset of the disease, the better the prognosis.…”

Section: Discussionmentioning

confidence: 99%

The management of Legg-Calvé-Perthes’ disease: Is there a consensus?

Hefti

Clarke

2007

Journal of Children's Orthopaedics

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Purpose The aim of the study was to find out whether or not there is consensus among experienced pediatric orthopaedists about the management of certain clinical scenarios in Legg-Calvé-Perthes' disease. Methods A questionnaire was sent to all 297 members of the European Paediatric Orthopaedic Society (EPOS) describing four cases of Legg-Calvé-Perthes' disease (LCPD) with two X-rays each and a short description of the clinical scenario. Two of the patients were younger and two were older than six years of age. From both age groups there was one with a good range of motion and an X-ray classified as Herring A or B, while the other patient had a poor range of motion and an X-ray classified as Herring C. EPO members were asked to choose from various treatment options or to describe any other therapy that they would advise in the clinical scenarios. Results One-hundred and fifty members answered the questionnaire. The participants had an average of 20 years of experience in pediatric orthopaedics. There was a consensus that no surgery should be performed in a young patient with a good range of motion and that there should be no weight relief when older with a good range of motion. Conservative containment treatment (abduction splint, Petrie cast) and arthrodiastasis was suggested in only very few centres. There was a tendency to perform• an operation when the patient is older with a poor range of motion and to perform operative treatment only when there were subluxation or head at risk signs.• pelvic osteotomies or a combination of pelvic and femoral osteotomies rather than femoral osteotomies alone. Age did not determine the indication for treatment and there was no agreement on the indications for physiotherapy. There was also no consensus on the type of pelvic osteotomy to be used. ConclusionsThe study showed that indications for the treatment of LCPD is based more on the personal experience of the surgeon rather than on scientific data.

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Morbus Perthes

Kinderorthopädie in Der Praxis

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Prognosis in Perthes' disease after noncontainment treatment

Cited by 36 publications

References 14 publications

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

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

The management of Legg-Calvé-Perthes’ disease: Is there a consensus?

Morbus Perthes

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