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The acetabulum in Perthes' disease: a prospective study of 123 children
S Huhnstock1, S Svenningsen, A H Pripp
1Department of Pediatric Orthopaedic Surgery, Oslo University Hospital, Rikshospitalet, 0027, Oslo, Norway, uxhuhs@ous-hf.no.
Insights
Acetabular dysplasia worsens during Perthes' disease. However, early acetabular changes do not predict poor femoral head shape at 5 years, suggesting limited prognostic value of routine monitoring.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Radiology
Background:
- Perthes' disease, a childhood hip condition, involves femoral head necrosis.
- Acetabular morphology changes are common during the disease course.
- Understanding these changes is crucial for predicting long-term outcomes.
Purpose of the Study:
- To evaluate radiographic changes in the acetabulum during Perthes' disease.
- To determine if these acetabular changes correlate with femoral head sphericity 5 years post-diagnosis.
Main Methods:
- A cohort of 123 children with unilateral Perthes' disease (age ≥6 years, >50% femoral head necrosis) was studied.
- Pelvic radiographs were taken at diagnosis, 1 year, and 5 years.
- Measurements included Sharp's angle, acetabular depth-to-width ratio (ADR), and lateral acetabular inclination.
Main Results:
- Perthes' hips showed significantly increased Sharp's angles and upward-sloping lateral margins compared to unaffected hips.
- Acetabular depth-to-width ratio was significantly lower in affected hips throughout the study.
- Lower ADR at diagnosis was associated with a more spherical femoral head at 5 years (OR 1.012).
Conclusions:
- The acetabulum tends to develop a dysplastic shape as Perthes' disease progresses.
- Early acetabular dysplasia does not appear to predict poor radiological outcomes at 5 years.
- Routine measurement of acetabular changes offers limited prognostic value in clinical practice.
Purpose:
We assessed the radiographic changes of the acetabulum during the course of Perthes' disease and investigated whether they were associated with femoral head sphericity 5 years after diagnosis.
Methods:
We studied 123 children with unilateral Perthes' disease, femoral head necrosis more than 50 % and age at diagnosis 6 years or older. Pelvic radiographs were taken at onset, 1 year and 5 years after diagnosis. Sharp's angle, acetabular depth-to-width ratio (ADR) and lateral acetabular inclination were measured.
Results:
Compared to the unaffected hips, the Perthes' hips developed significantly higher Sharp's angles (p < 0.001) and a higher proportion with an upward-sloping lateral acetabular margin (Perthes' hips: 49 %, unaffected hips 1 %). The mean ADR values were significantly lower on the affected side at all stages (p < 0.001). ADR values at diagnosis were associated with a more spherical femoral head at the 5-year follow-up [odds ratio (OR) 1.012, 95 % confidence interval (CI) 1.002-1.022, p = 0.016]. None of the other acetabular parameters were significantly associated with the femoral head shape 5 years after diagnosis.
Conclusion:
The acetabulum developed an increasingly dysplastic shape in the course of Perthes' disease. Early dysplastic changes of the acetabulum were not associated with a poor radiological outcome 5 years after diagnosis. Routine measurement and monitoring of acetabular changes in plain radiographs were of little prognostic value and can, therefore, hardly be recommended in clinical practice.
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