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The Natural History of Non-operatively Managed Legg-Calvé-Perthes' Disease
Ramez Ailabouni1, Bryn O Zomar2,3, Bronwyn L Slobogean4
1Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
Insights
Legg-Calvé-Perthes disease (LCPD) shows similar radiographic progression and outcomes in British Columbia and India. Differences in classification system distribution between the two regions require further investigation for LCPD patients.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Radiology
Background:
- Legg-Calvé-Perthes disease (LCPD) is a hip disorder affecting children.
- Non-operative treatment is common for LCPD.
- Previous studies on LCPD outcomes exist from India.
Purpose of the Study:
- To examine the evolution of Legg-Calvé-Perthes disease (LCPD) in Canadian children treated non-operatively.
- To compare LCPD outcomes in British Columbia (BC) with a cohort from India.
Main Methods:
- Retrospective review of 102 hips (90 patients) with LCPD treated non-operatively in BC (1990-2006).
- Comparison with a previously studied Indian cohort.
- Radiographic assessment using modified Waldenstrom, Catterall, Salter-Thompson, Herring, Mose, and modified Stulberg classifications; evaluation of epiphyseal extrusion (EE) and metaphyseal width (MW).
Main Results:
- BC cohort predominantly presented with Waldenstrom stages I and II (95%), while the Indian cohort presented with stage IIIa (90%).
- Final epiphyseal extrusion (BC 26.8%, India 27.3%) and metaphyseal width (119% in both groups) were similar.
- Modified Waldenstrom and Herring classifications showed substantial reliability; Catterall and Salter-Thompson showed moderate agreement.
Conclusions:
- Radiographic progression and final appearance of LCPD are similar between India and BC.
- Discrepancies in classification system distribution between the cohorts warrant further investigation.
Background:
The purpose of this study was to examine the evolution of Legg-Calvé-Perthes' disease (LCPD) among children from British Columbia (BC), Canada who were treated non-operatively and to compare the results to a previously conducted study in India.
Methods:
This was a retrospective review of patients treated non-operatively for LCPD in BC between 1990 and 2006 compared with a cohort from India. Demographic and treatment information were collected from medical records. Radiographs were assigned modified Waldenstrom, Catterall, Salter-Thompson and Herring classifications and intra- and interobserver reliability were assessed. We evaluated epiphyseal extrusion (EE) and metaphyseal width (MW), and assessed radiographs using the Mose and modified Stulberg classifications.
Results:
102 hips (90 patients) had radiographs available for evaluation. 95% of the BC cohort presented as Waldenstrom stages I and II, whereas, 90% of the Indian cohort presented as IIIa. Final EE was similar for both groups (BC 26.8%, India 27.3%) and final MW was 119% in both groups. Modified Waldenstrom and Herring classifications had substantial intra- and interobserver reliability, while Salter-Thompson and Catterall classifications had moderate agreement at best. Most hips were Catterall IV (80%) and Herring C (89%) for the BC cohort compared to only 44% and 43% of Indian hips, respectively. Most hips were irregular according to the Mose classification (BC 43%, India 52%) and aspherical according to the Stulberg classification (BC 78%).
Conclusions:
We found similar radiographic progression and final radiographic appearances of LCPD in India and BC though differences in the distribution of the classification systems warrant further study.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s43465-021-00543-x.
