Prognostic Value of Modified Lateral Pillar Classification in Legg-Calvé-Perthes Disease

Lee, Dam Seon; Jung, Sung Taek; Kim, Ki Hyeong; Lee, Jae Joon

doi:10.4055/cios.2009.1.4.222

Cited by 12 publications

(4 citation statements)

References 18 publications

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“…In addition to the radiological risk factors, table 1 also shows the clinical factors and their relevance to a poor prognosis. Many long-term studies have verified this [19][20][21][22].…”

Section: Incidencementioning

confidence: 75%

Legg-Calvé-Perthes Disease and Its Physiotherapy - “If the Hip Melts Away”

AH¹

2018

ORP

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ClassificationsThe disease progresses into 4 chronological stages ( Figure 1):• Condensation stage (Ø 7 months)• Fragmentation stage (Ø 8.5 months)• Reossification stage (Ø 18 months)• End stage [15] Krieg AH, et al., J Orthop Res Physiother 2018, 3: 037 Abstract Legg-Calvé-Perthes disease (or Perthes disease) is a disorder of the hip, which is caused by a vascular disorder ischemia of the femoral head and passes through four stages. It affects mostly infants and children of caucasian population. The cause of the ischemia is not yet known and therefore cannot be prevented norreversed. Limping, restriction of the movement and pain can lead to the diagnosis. X-rays as well as Magnetic Resonance Imaging (MRI) confirms it. The classification of Herring (A-C) is helpful to make a clinical prognosis and further treatment. The main aim of therapy is to improve joint the mobility and the joint's congruence ("containment"), build up muscle strength and reduce pain. Physiotherapy is an undisputed method, lasts over years involving an extensive movement therapy of the affected hip, the torso and the non-affected limb. Short-term drug-related analgesia, botulinum injection into the adductors and a weight relief can accompany therapy. An indication for operative treatment is given by subluxation within stadium B or B/C of Herring. Containment (hip centering/ joint's congruence) can be achieved by femoral varization osteotomy or pelvic osteotomy. Only one quarter of all patients is treated with surgery and physiotherapy remains the most relevant therapy on Perthes disease.

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“…In addition to the radiological risk factors, table 1 also shows the clinical factors and their relevance to a poor prognosis. Many long-term studies have verified this [19][20][21][22].…”

Section: Incidencementioning

confidence: 75%

Legg-Calvé-Perthes Disease and Its Physiotherapy - “If the Hip Melts Away”

AH¹

2018

ORP

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“…The second limitation was the use of Catterall, Herring and Stulberg classifications, initially described for the Legg-Calve-Perthes disease in order to determine the severity of the disease and prognosis. 24 , 25 To the best of our knowledge, these have never been used for the description of the ONFH in children with SCD. Catterall and Herring classifications were essentially used in the current study to objectively describe the extension of epiphyseal lesions since there is no specific classification for ONFH in SCD children.…”

Section: Discussionmentioning

confidence: 99%

Management of osteonecrosis of the femoral head in children with sickle cell disease: Results of conservative and operative treatments at skeletal maturity

Mallet

Vidal

et al. 2018

Journal of Children's Orthopaedics

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PurposeSickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children.MethodsAll children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures.ResultsA total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4.ConclusionBoth treatments led to good functional results with 75% of congruent hips at skeletal maturity.Level of EvidenceIV

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“…The resulting coxa vara deformity may not remodel and therefore may produce a long-term limp due to abductor muscle dysfunction because the abductor lever arm and muscle tension are altered (Noonan et al 2001 ). A pelvic osteotomy alone for containment is more limited in its amount of coverage (Rowe et al 2006 ;Lee et al 2009 ). All these methods are contraindicated if the hip is stiff, especially if it cannot abduct suffi ciently; these hips are suitable for a salvage procedure.…”

Section: Discussionmentioning

confidence: 99%