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Operative versus nonoperative treatments for Legg-Calvé-Perthes disease: a meta-analysis
Nhu-An T Nguyen1, Guy Klein, Godwin Dogbey
1Ohio University College of Osteopathic Medicine, Athens, OH, USA.
Insights
Operative treatment for Legg-Calvé-Perthes disease (LCPD) is more effective for children aged 6 and older, improving radiographic outcomes. For younger children, both operative and nonoperative methods yield similar results, with pelvic procedures showing better outcomes in those under 6.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Regenerative Medicine
Background:
- Legg-Calvé-Perthes disease (LCPD) is a childhood condition involving avascular necrosis of the femoral head.
- Current treatment protocols for pediatric LCPD lack a definitive consensus between operative and nonoperative approaches.
Purpose of the Study:
- To analyze and compare the radiographic outcomes of operative versus nonoperative treatments for pediatric LCPD.
- To evaluate the influence of patient age and surgical procedure type on treatment success.
Main Methods:
- A meta-analysis of clinical studies published between 1960 and 2010 was conducted.
- Included studies required a minimum of 10 patients, age at diagnosis, initial severity assessment (Herring or Catterall), intervention details, and radiographic reassessment (Mose or Stulberg) after at least one year.
- A binary logistic regression model was used to analyze radiographic outcomes.
Main Results:
- Operative treatment showed significantly better radiographic outcomes in patients aged 6 years and older (OR=1.754, P<0.0001).
- In patients younger than 6 years, operative and nonoperative treatments yielded similar radiographic outcomes (OR=1.071, P=0.828).
- For patients younger than 6 years, pelvic procedures were associated with better outcomes than femoral procedures (OR=5.20, P=0.034).
Conclusions:
- Operative treatment is recommended for children aged 6 and older with LCPD to achieve a more spherical femoral head.
- For children under 6, nonoperative and operative treatments show comparable radiographic success rates.
- Among younger children treated operatively, pelvic procedures demonstrated superior radiographic outcomes compared to femoral procedures.
Background:
Legg-Calvé-Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head primarily affecting children of ages 4 to 12 years. There is no clear consensus on nonoperative or operative treatment protocols for pediatric patients presenting with LCPD. This study uses meta-analysis and a binary logistic regression model to analyze the radiographic outcomes of these treatment modalities in pediatric patients.
Methods:
Clinical studies describing patients undergoing either nonoperative or operative treatment of LCPD published from 1960 through 2010 were searched electronically and manually. Eligible studies consisted of (1) a minimum of 10 patients; (2) listed age at the time of diagnosis or treatment; (3) performed an initial severity assessment using the Herring or Catterall classification; (4) detailed the type of intervention; and (5) reassessment of radiographic outcome after a minimum of 1 year after treatment using the Mose or Stulberg classification.
Results:
Twenty-three studies, 1232 patients, and 1266 hips met the inclusion criteria. Among patients younger than 6 years, operative and nonoperative treatments are equally as likely to results in a successful radiographic outcome [odds ratio (OR)=1.071; P=0.828; 95% confidence interval (CI), 7.377-32.937]. In patients older than 6 years, operative treatment is nearly twice as likely to result in a successful radiographic outcome (OR=1.754; P<0.0001; 95% CI, 1.299-2.370). For age at treatment less than 6 years, a patient treated with a pelvic rather than femoral procedure was approximately 5 times as likely to have a good radiographic outcome (χ=4.488; P=0.034; unadjusted OR=5.20; 95% CI, 1.021-26.471). Among patients ages 6 or older, pelvic procedures were equally as likely as femoral procedures to yield a successful radiographic outcome (χ=1.845; P=0.174; unadjusted OR=1.329; 95% CI, 0.881-2.004). Sex had no significant influence on radiographic outcome (OR=1.248; P=0.486; 95% CI, 0.670-2.325).
Conclusions:
This meta-analysis suggests that operative treatment is more likely to yield a spherical congruent femoral head than nonoperative methods among patients 6 years or older. Among patients younger than 6 years, operative and nonoperative methods have the same likelihood to yield a good outcome. Patients who were 6 years or older were treated operatively, and had the same likelihood of a good radiographic outcome regardless of treatment with femoral or pelvic procedures. Among patients younger than 6 years, pelvic procedures were more likely to result in a good radiographic outcome than femoral procedures.
Level Of Evidence:
Level IV meta-analysis.
