Legg-Calvé-Perthes disease: classifications and prognostic factors
Virginie Rampal1, Jean-Luc Clément1, Federico Solla1
1Pediatric Orthopaedic Surgery, Lenval University Children's Hospital, Nice, France.
Insights
Legg-Calvé-Perthes Disease (LCPD) prognosis is influenced by clinical factors like overweight, female sex, older age, and limited hip abduction. Radiological signs and MRI are key for predicting outcomes in pediatric avascular necrosis.
Area of Science:
- Pediatric Orthopedics
- Avascular Necrosis Research
- Biomedical Engineering
Background:
- Legg-Calvé-Perthes Disease (LCPD) is idiopathic avascular necrosis of the femoral head in children.
- Treatment decisions rely on predicting femoral head sphericity and hip congruence at skeletal maturity.
Purpose of the Study:
- To review and highlight prognostic factors for Legg-Calvé-Perthes Disease (LCPD).
Main Methods:
- A systematic literature search was conducted using PubMed.
- 33 articles focusing on LCPD prognostic factors and classification were selected.
Main Results:
- Poor prognostic clinical indicators include overweight, female sex, age over 6 years, and limited hip abduction.
- Herring's classification is a reliable radiological tool for prognosis.
- "At-risk" femoral head signs and reduced acetabular-femoral head congruence indicate poor outcomes.
Conclusions:
- Clinical and radiological factors significantly predict LCPD outcomes.
- MRI shows promise for assessing hip prognosis in LCPD.
- Further understanding of LCPD etiology may refine prognosis.
Introduction:
Legg-Calvé-Perthes Disease (LCPD) represents idiopathic avascular necrosis of femoral head in pediatric population. Indications for treatment depend mostly on prognosis about femoral head sphericity and hip congruence at the end of growth. The aim of this review is to highline prognostic factors of LCPD.
Methods:
Bibliographic search in PubMed allowed selection of 33 articles concerning prognostic factors and/or classification of LCPD.
Conclusion:
Clinical factors of poor prognosis are overweight, female sex, age exceeding 6 years old, and lack of hip abduction. Radiologically, Herring's classification is consensual because of its high prognostic value and very good reproducibility. The other signs of femoral head "at-risk" and the assessment of the reduction in abduction of the femoral head in the acetabulum are also prognostic of late evolution. MRI seems to be a future tool in assessing the fate of hips in LCPD. It is likely that a better understanding of LCPD etiology would precise the prognosis of this disease.
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