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Comparative effectiveness of treatment modalities in severe Legg‑Calvé‑Perthes disease: Systematic review and network
Nath Adulkasem1, Phichayut Phinyo2,3,4, Pasin Tangadulrat1
1Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand.
Insights
Combined osteotomy is the most effective treatment for severe Legg-Calvé-Perthes disease (LCPD), improving hip joint congruity. This surgical approach shows superior outcomes compared to other methods for this childhood condition.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Surgical Innovation
Background:
- Legg-Calvé-Perthes disease (LCPD) involves avascular osteonecrosis of the femoral head in children.
- Current treatments aim for femoral head containment, but consensus for severe LCPD is lacking.
- Comparative effectiveness of various LCPD treatments requires further investigation.
Purpose of the Study:
- To compare the effectiveness of different treatment modalities for severe Legg-Calvé-Perthes disease.
- To identify the optimal treatment for achieving radiographic spherical congruity of the hip joint post-treatment.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Scopus databases up to July 2021.
- A network meta-analysis evaluated comparative effectiveness using radiographic spherical congruity as the primary outcome.
- Treatment rankings were determined using Surface Under the Cumulative Ranking curve (SUCRA) analysis.
Main Results:
- 34 studies involving 3718 hips compared seven LCPD treatment modalities.
- Combined osteotomy demonstrated the highest effectiveness (RR=1.47, SUCRA=0.8) compared to symptomatic treatment.
- Femoral varus osteotomy (RR=1.31, SUCRA=0.7) and Salter innominate osteotomy (RR=1.25, SUCRA=0.6) also showed significant benefits.
Conclusions:
- Combined osteotomy is the most effective procedure for improving hip joint spherical congruity in severe LCPD.
- The benefits of operative treatments may be more pronounced in patients older than eight years.
- Further research may refine treatment strategies based on patient age and disease severity.
Purpose:
There are several treatment modalities for Legg-Calvé-Perthes disease (LCPD), self-limiting, avascular osteonecrosis of the femoral head in children. Most treatments focus on containment of the weakened femoral head, but there is no consensus on the best modality for severe LCPD. Therefore, we compared the effectiveness of all treatment modalities for severe LCPD.
Materials And Methods:
We searched the PubMed, Embase, and Scopus up until July 2021 for studies that investigated LCPD treatment effectiveness. A network meta-analysis was performed to examine the comparative effectiveness in terms of the ability to achieve radiographic spherical congruity of the hip joint after skeletal maturity. The risk ratio (RR) and 95% confidence interval (CI) of each treatment modality were estimated from both direct and indirect evidence. Treatment ranking was based on Surface Under the Cumulative Ranking curve (SUCRA).
Results:
A total of 857 studies were identified and 34 comparative studies with 3718 affected hips comparing seven different LCPD treatment modalities were included. Compared with symptomatic treatment, combined osteotomy was the most effective modality (RR = 1.47, 95% CI 0.90 to 2.42, SUCRA = 0.8), followed by femoral varus osteotomy (RR = 1.31, 95% CI 1.06 to 1.60, SUCRA = 0.7), and Salter innominate osteotomy (RR = 1.25, 95% CI 0.95 to 1.65, SUCRA = 0.6).
Conclusions:
Combined osteotomy is the most effective procedure in terms of improving the spherical congruity of the hip joint in severe LCPD patients. However, the superiority of operative treatments seems to be limited to patients older than eight years old.
