The Natural History of Perthes' Disease

Norlin, Rolf; Hammerby, Staffan; Tkaczuk, H.

doi:10.1097/01241398-199111000-00044

Cited by 3 publications

(3 citation statements)

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“…Older age and whole femoral head involvement are poor prognostic factors (Ippolito et al 1987 ;Norlin et al 1991 ;Mazda et al 1999 ;Eyre-brook 1936 ). Treatment by bed rest, non-weight bearing, and abduction orthosis is of limited value and is not well tolerated (Kamhi and MacEwen 1975 ;Meehan et al 1992 ;Eaton 1967 ;Martinez et al 1992 ).…”

Section: Discussionmentioning

confidence: 99%

Joint Distraction for Special Conditions

Paley¹,

Lamm

2014

Advanced Techniques in Limb Reconstruction Surgery

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Section: Discussionmentioning

confidence: 99%

Joint Distraction for Special Conditions

Paley¹,

Lamm

2014

Advanced Techniques in Limb Reconstruction Surgery

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“…Attributed to Waldenström [48], the stages of LCPD include necrosis/initial, fragmentation, reossification/healing, and residual. LCPD is associated with substantial hip pain and dysfunction both during the disease process as well as later in adulthood in 39% to 70% of patients at 22 to 47 years followup [36,41,46]. Although morbidity appears to be related to the morphologic changes that are present in the final and healed stage of the disease [15], emphasis is on radiographic features that may predict asphericity of the femoral head [6,16,25,44].…”

Section: Introductionmentioning

confidence: 99%

Do Femoral or Salter Innominate Osteotomies Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease? A Meta-analysis

Saran

Varghese

Mulpuri

2012

Clinical Orthopaedics &Amp; Related Research

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Background Recently, the authors of two prospective multicenter observational studies recommended surgery to improve head sphericity in older children, whereas large retrospective observational studies suggest that surgery does not improve head sphericity in older children. Thus, the treatment for Legg-Calvé-Perthes disease (LCPD) remains controversial. Questions/purposes Using a meta-analysis we asked whether femoral varus osteotomy (FVO) or Salter innominate osteotomy (SIO) resulted in better radiographic head sphericity at the end of the disease process as compared with nonsurgical modalities. Methods We systematically searched the literature using the key concepts LCPD, operative treatment, and nonoperative treatment. Of 160 abstracts, 57 full-text studies were reviewed and 14 papers chosen for meta-analysis. Subgroup analyses were performed to assess the impact of age and stage of disease. The odds of a spherical head after operative compared with nonoperative treatment were calculated to measure effect size for each study and a pooled odds ratio (OR) calculated. Results Head sphericity improved (OR, 1.29; 95% CI, 1.05-1.60) by FVO or SIO as compared with patients treated nonoperatively. In children younger than 6 years, it did not alter femoral head sphericity (OR, 1.02; 95% CI, 0.45-2.36); children 6 years of age and older were more likely to have better femoral head sphericity from surgical treatment than nonoperative treatment (OR, 2.05; 95% CI, 1.28-3.26). Conclusions The data suggest FVO or SIO in patients with LCPD disease who are older than 6 years of age during or before the fragmentation phase should be considered. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…The most widely accepted theories involve repeated vascular interruption of the blood supply to the femoral head which results in venous occlusion with subsequent venous hypertension and bone death. [1][2][3][4] Recent reports have suggested that heritable thrombophilic disorders may be one of the pathogenetic causes of Perthes' disease. 5,6 Congenital thrombophilia, leading to an increased tendency to early thrombosis, may be caused by various disorders.…”

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confidence: 99%

Does thrombophilia play an aetiological role in Legg-Calvé-Perthes disease?

Hayek

Kenet

Lubetsky

et al. 1999

The Journal of Bone and Joint Surgery. British volume

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H eritable thrombophilic disorders have been proposed as one of the causes for Legg-Calvé-Perthes disease. A total of 62 patients diagnosed with this disease between 1988 and 1997 and 50 controls were screened for thrombophilia. The incidence and relationship of thrombophilia to the severity of the disease were evaluated.One patient and none of the controls had protein S deficiency. One of the control group and one of the patients had protein C deficiency with the latter child also having a combined deficiency with a mutant factor V gene.The number of children with a mutant factor V gene, protein C deficiency, who were homozygous for the C 677T polymorphism of methylenetetrahydrofolate reductase or were heterozygous for mutant G20210A prothrombin did not differ statistically in the study and the control groups. No patient had antithrombin deficiency or positive lupus anticoagulant.We found no correlation between thrombophilia and the extent of the disease. The most common risk factors for arteriovenous thromboembolism showed no statistical significance in our patients compared with the control group or with the general population. These data do not confirm an aetiological role for thrombophilia in Perthes' disease. J Bone Joint Surg [Br] 1999;81-B:686-90.

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The Natural History of Perthes' Disease

Cited by 3 publications

References 0 publications

Joint Distraction for Special Conditions

Joint Distraction for Special Conditions

Do Femoral or Salter Innominate Osteotomies Improve Femoral Head Sphericity in Legg-Calvé-Perthes Disease? A Meta-analysis

Does thrombophilia play an aetiological role in Legg-Calvé-Perthes disease?

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