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Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review
Arash Maleki1, Seyyed Mohammad Qoreishy1, Mohammad Nabi Bahrami1
1Orthopedic Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Legg-Calvé-Perthes disease (LCPD) treatment outcomes depend on age, femoral head involvement, and surgical method. Early intervention and dynamic arthrography aid in choosing optimal surgical techniques for LCPD.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Surgical Innovation
Background:
- Legg-Calvé-Perthes disease (LCPD) affects children aged 2-15, disrupting blood supply to the femoral head.
- Various surgical and non-surgical treatments exist for non-containable LCPD hips.
Purpose of the Study:
- To comprehensively review and investigate diverse surgical techniques for treating Legg-Calvé-Perthes disease (LCPD).
Main Methods:
- Systematic literature search across major databases (PubMed, MEDLINE, Web of Science, etc.) from October 8-14, 2020.
- Inclusion criteria based on title, abstract, and full-text screening; quality assessment and data extraction from 22 selected studies.
Main Results:
- Treatment outcomes for Perthes disease are influenced by onset age, femoral head involvement severity, and chosen treatment method.
- Prognosis varies with age: good for <6 years, variable for 6-8 years, and poor for >8 years, though advanced surgery can help older children.
- Dynamic arthrography is recommended for observing signs and guiding treatment decisions.
Conclusions:
- This review offers clinicians a concise guideline for managing patients with Legg-Calvé-Perthes disease.
- Highlights the importance of considering age and disease severity in surgical approach selection.
Background:
Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips.
Objective:
The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD.
Methods:
An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles.
Results:
A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach.
Conclusions:
This review provides clinicians with a brief guideline for the treatment of patients with LCPD.
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