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Can residual leg shortening be predicted in patients with Legg-Calvé-Perthes' disease?
Kwang-Won Park1, Kyu-Seon Jang, Hae-Ryong Song
1Institute for Rare Diseases and Department of Orthopaedic Surgery, Korea University Medical Center, Guro Hospital, 80, Guro-Dong, Guro-Gu, Seoul, 152-703, Korea.
Insights
Legg-Calvé-Perthes disease (LCPD) can cause leg length discrepancy (LLD). Femoral head involvement severity, not age or surgery, predicts LLD in children with LCPD.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Skeletal Dysplasias
Background:
- Legg-Calvé-Perthes disease (LCPD) often leads to femoral head deformity and leg length discrepancy (LLD).
- Predictive factors for residual shortening in LCPD patients remain unclear.
Purpose of the Study:
- To identify predictors of leg length discrepancy (LLD) at skeletal maturity in patients with Legg-Calvé-Perthes disease (LCPD).
- Investigate the association between femoral head involvement, varus osteotomy, and demographic factors with LLD.
Main Methods:
- Retrospective review of 168 skeletally mature patients with unilateral LCPD.
- Assessment of femoral head involvement using Herring lateral pillar and Catterall classifications.
- LLD defined as ≥ 1.0 cm shortening; patient sex and treatment modalities were recorded.
Main Results:
- 55% of patients developed LLD (mean 19 mm), associated with femoral head involvement extent.
- Varus osteotomy did not correlate with residual shortening.
- Lateral pillar classification B/C or C was the strongest predictor of LLD (OR 3.5).
Conclusions:
- The extent of femoral head involvement is a significant predictor of LLD in unilateral LCPD.
- Patient age at diagnosis, sex, and treatment modality do not predict LLD at skeletal maturity.
Background:
Although Legg-Calvé-Perthes' disease (LCPD) is frequently associated with varying degrees of femoral head deformity and leg length discrepancy (LLD), no factors that predict residual shortening have been clearly identified.
Questions/Purposes:
We attempted to determine whether (1) the extent of femoral head involvement; (2) varus osteotomy; and (3) patient demographic characteristics are associated with LLD at skeletal maturity in patients with LCPD.
Methods:
We retrospectively reviewed the records of 168 skeletally mature patients with unilateral LCPD. The mean age at diagnosis was 7 years (range, 2-14 years). The extent of femoral head involvement was determined from the initial radiographs using the Herring lateral pillar and Catterall classifications. LLD was defined as shortening by ≥ 1.0 cm as measured from scanograms. The patient's sex and the treatment modalities used were also recorded.
Results:
LLD ranging from 10 to 38 mm (mean, 19 mm) occurred in 93 (55%) patients and was associated with the extent of femoral head involvement. Varus osteotomy was not associated with residual shortening. The patient's age at diagnosis did not affect the LLD at skeletal maturity. The strongest predictor of LLD was a lateral pillar classification of B/C or C (odds ratio, 3.5; 95% confidence interval, 1.39-8.79).
Conclusions:
The extent of femoral head involvement, but not the patient's age at diagnosis or sex or the treatment modality, can predict the LLD at skeletal maturity in patients with unilateral LCPD.
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