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Updated: Aug 9, 2025

In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
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Skeletal Maturity in Legg-Calve-Perthes Disease: Significant Discrepancy Present Between the Hand and the Hip

K Aaron Shaw1, John A Herring

  • 1Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX.

Journal of Pediatric Orthopedics
|February 15, 2023
PubMed

Insights

Legg-Calve-Perthes Disease (LCPD) patients show delayed skeletal maturity with the Greulich and Pyle (GP) atlas. The Optimized Oxford system offers a more accurate skeletal age assessment in LCPD, closely matching chronological age.

Area of Science:

  • Pediatric Orthopedics
  • Radiology
  • Skeletal Development

Background:

  • Legg-Calve-Perthes Disease (LCPD) is associated with delayed skeletal maturity, typically 1-2 years behind chronological age using the Greulich and Pyle (GP) atlas.
  • The Optimized Oxford hip skeletal age (Optimized Oxford) system is a newer method for assessing skeletal maturity.
  • The Optimized Oxford system's accuracy in LCPD patients has not been previously evaluated.

Purpose of the Study:

  • To compare skeletal maturity assessment between the GP atlas and the Optimized Oxford system in children with LCPD.
  • To evaluate the accuracy of the Optimized Oxford system in determining bone age for LCPD patients.
  • To analyze potential sex differences in skeletal maturity assessment within LCPD.

Main Methods:

  • Retrospective review of a multicenter study cohort of LCPD patients treated between 1984-1991.
  • Inclusion criteria required left-hand radiographs for GP bone age and contralateral hip radiographs for Optimized Oxford bone age at presentation.
  • Skeletal maturity indices were compared to chronological age (CA) to determine discrepancies.

Main Results:

  • The GP atlas indicated a mean skeletal age 1.4 years younger than CA, with greater delay in boys.
  • The Optimized Oxford system showed a mean skeletal age 0.31 years older than CA, with strong correlation to CA and no significant sex differences.
  • The GP bone age was significantly younger than the Optimized Oxford bone age by a mean of 1.7 years.

Conclusions:

  • Skeletal maturity assessment in LCPD varies significantly depending on the method used.
  • The Optimized Oxford system provides a more accurate reflection of chronological age in LCPD patients compared to the GP atlas.
  • The GP atlas underestimates skeletal maturity in LCPD, confirming delayed maturation, while the Optimized Oxford system does not show this delay.
Abstract

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