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Declining Rates of Legg-Calvé-Perthes Surgery in the United States: National Trends Using the Kids' Inpatient
Jaren LaGreca1,2, Amanda Nickel3, Michael Finch3
1Gillette Children's Specialty Healthcare, Saint Paul.
Insights
Surgical management of Legg-Calvé-Perthes disease (LCPD) has decreased since 2000, with no change in age group proportions. Femoral osteotomy remains the primary procedure, while other osteotomies have declined.
Area of Science:
- Pediatric Orthopedics
- Surgical Trends Analysis
- Epidemiology of Musculoskeletal Disorders
Background:
- Landmark studies in 2004 and 2008 improved understanding of surgical indications for Legg-Calvé-Perthes disease (LCPD).
- These studies emphasized patient age, disease severity, and radiographic outcomes in treatment decisions.
- Previous understanding of operative indications for LCPD has been refined by these key publications.
Purpose of the Study:
- To evaluate trends in the surgical management of Legg-Calvé-Perthes disease (LCPD) in the United States.
- To analyze surgical trends before and after the publication of significant 2004 and 2008 studies.
- To assess changes in LCPD surgical procedures and patient demographics over time.
Main Methods:
- Retrospective analysis of US pediatric hospitalizations for LCPD surgery (2000-2016) using the Kids' Inpatient Database.
- Inclusion criteria: patients ≤12 years with primary LCPD diagnosis and LCPD-related procedure.
- National estimates were generated via weighted data; post hoc analysis used the Pediatric Health Information System database for corroboration.
Main Results:
- A total of 2786 LCPD surgical admissions were analyzed.
- Admissions for LCPD surgery significantly decreased across all age groups over time.
- Femoral osteotomy remained the most common procedure, while other osteotomies (pelvic, unspecified) decreased (P <0.001).
Conclusions:
- Hospital admissions for Legg-Calvé-Perthes disease (LCPD) surgery have declined since 2000, potentially indicating a reduced incidence.
- Despite evidence linking LCPD surgical outcomes to patient age, the proportion of patients undergoing surgery by age group has not changed.
- The study highlights evolving surgical practices in pediatric orthopedics for LCPD management.
Background:
In 2004 and 2008 two large prospective, multicenter studies were published which resulted in improved understanding of operative indications for the treatment of Legg-Calvé-Perthes disease (LCPD) based on patient age, disease severity, and resultant radiographic outcomes. The primary aim of this study is to evaluate the trends in surgical management of LCPD in the United States prior, and subsequent to, the publication of these landmark studies.
Methods:
Cross-sectional retrospective analysis of US pediatric hospitalizations for the surgical management of LCPD was conducted using the Kids' Inpatient Database from 2000 to 2016. Patients 12 years of age and younger were included who had a primary admission diagnosis of LCPD and a LCPD-related procedure during the hospitalization. Data was subsequently weighted to produce national-level estimates and variables pertaining to patient age group, procedure, demographics, and hospital characteristics were analyzed. In a post hoc analysis, the results of the Kids' Inpatient Database were also corroborated with the Pediatric Health Information System database.
Results:
A weighted sample of 2786 LCPD surgical admissions met inclusion and exclusion criteria; 11.2% of surgical admissions were patients below 6 years of age, 35.9% were 6 to 8 years of age, and 52.9% were above 8 years of age. There was a significant decrease in admissions for surgical management of LCPD in all age groups over time, however there was no appreciable change in the proportion of LCPD surgical admissions performed among the above 8 to below 12, above 6 to below 8, or below 6 years age groups. Femoral osteotomy remained the most common surgical procedure, while other osteotomy types, including pelvic and unspecified osteotomies involving the hip, decreased over time ( P <0.001).
Conclusions:
There is a decreasing rate of hospital admissions for LCPD surgery since 2000, perhaps indicating a decline in incidence of disease. Furthermore, despite evidence supporting LCPD surgical outcomes related to patient age, there has been no change in the proportion of patients undergoing surgery by age group over time.
Level Of Evidence:
Level III-retrospective study.
