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[Legg-Calve-Perthes disease]
1Hôpital orthopédique de la Suisse romande, avenue Pierre-Decker 4, 1005 Lausanne, Suisse. Michel.Dutoit@chuv.ch
Insights
Legg-Calvé-Perthes disease (LCPD) treatment is challenging, with prognosis depending on age, necrosis extent, and hip extrusion. Current treatments aim to minimize femoral head deformity and prevent future arthritis.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Radiology
Context:
- Legg-Calvé-Perthes disease (LCPD) is a hip disorder affecting children.
- Accurate diagnosis and prognosis are crucial for effective management.
- Advances in imaging aid in treatment planning and outcome prediction.
Purpose:
- To review the definition, etiology, and clinical manifestations of LCPD.
- To highlight the importance of diagnostic investigations for prognosis.
- To discuss current conservative and surgical treatment strategies and their complications.
Summary:
- Key prognostic factors for LCPD include patient age at diagnosis, extent of epiphyseal necrosis (especially the lateral pillar), and hip extrusion.
- No causal treatment exists; management focuses on preventing femoral head deformity and secondary osteoarthritis.
- Prognosis is favorable in children under 5, but less so after age 9, even with surgical intervention.
Impact:
- Informs clinical decision-making for LCPD management.
- Aids in patient counseling regarding treatment outcomes and long-term prognosis.
- Contributes to understanding the natural history and optimal therapeutic approaches for LCPD.
Abstract:
Treatment of Legg-Calvé-Perthes disease remains, in spite of realized progresses, difficult and disturbing. The important factors for establishing diagnosis concerning definition, etiology, physiopathology and clinical manifestations are reminded. The role of present complementary investigations as well as their evolution are very important to better establish the prognosis and the treatment. The most important factors for treating and establishing the prognosis of LPC are: 1) age. The prognosis is good in almost every case before 5 years old, without any treatment; 2) the prognosis is not good after 9 years, also, very often, after surgical treatment; 3) area of the epiphyseal necrosis, particularly of the lateral pillar; 4) extrusion of the hip at any age. Today, there is always no causal treatment of Legg-Calvé-Perthes disease. Conservative and surgical treatment aims to prevent deformities of the femoral head accompanied or not by articular incongruency, responsible for hip arthritis from the fourth decade. The place of conservative and surgical treatment as well as their complications are described; it aims to guide the spontaneous recovery with as little as possible, deformation of the femoral epiphysis.
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