Related Experiment Video
Updated: Sep 14, 2025
In Vivo Quantification of Hip Arthrokinematics during Dynamic Weight-bearing Activities using Dual Fluoroscopy
Published on: July 2, 2021
Early-Onset Perthes Disease in Patients Under 4 Years of Age: Natural Disease History, Radiographic Findings, and
Jaime Garcia-Fernandez1, Juan Carlos Abril1,2, Paloma Manzarbeitia-Arroba1
1Department of Orthopaedic, Hospital Infantil Universitario Niño Jesús.
Insights
Early-onset Legg-Calvé-Perthes disease (LCPD) in children under 4 can lead to poor outcomes. Radiographic signs like ovalization predict final femoral head asphericity, guiding early surgical intervention.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Skeletal Dysplasia
Background:
- Early-onset Legg-Calvé-Perthes disease (LCPD) in children under 4 years old often has favorable outcomes, but approximately 30% develop poor long-term results.
- Identifying prognostic indicators early is crucial for timely surgical management in pediatric hip conditions.
Purpose of the Study:
- To describe the natural history of LCPD in patients diagnosed before age 4.
- To evaluate the correlation between radiographic findings and final outcomes in early-onset LCPD.
Main Methods:
- Analysis of serial radiographs in 104 patients (142 hips) with LCPD onset before age 4, followed to skeletal maturity.
- Assessment of Herring classification, collapse index (Co-index), Reimer's migration index (RMI), ellipsoidal index, intraphyseal angle, and double ossification nucleus.
- Correlation of radiographic parameters with final outcomes using Stulberg classification and sphericity deviation score (SDS).
Main Results:
- 36% of hips progressed to Stulberg grades III-V, indicating poor outcomes, with a mean SDS of 40.0.
- Herring B classification was most common (88 hips), with a mean Co-index of 11.7% and mean RMI of 16.2%.
- Final femoral head asphericity in poor outcome hips was characterized by physeal angulation (79.5%), double ossification nucleus (89%), and increased ellipsoidal index.
Conclusions:
- Early-onset LCPD does not invariably lead to favorable outcomes, with a significant proportion developing final femoral head asphericity.
- The ovalization process, evidenced by specific radiographic findings, can predict the development of asphericity in LCPD.
Introduction:
Early-onset Legg-Calvé-Perthes disease (LCPD) is commonly associated with favorable long-term outcomes; however, this is not guaranteed, as ~30% of these cases eventually develop poor outcomes. Identifying hips with poor prognostic indicators at an early age is crucial to guide appropriate surgical management. This study aims to describe the natural history of LCPD in patients diagnosed before the age of 4 and evaluate the correlation between radiographic findings and final outcomes.
Methods:
All patients with LCPD onset before the age of 4 who followed a natural progression were included in this study. Serial radiographs were analyzed until skeletal maturity. Herring classification for femoral head collapse was assessed, alongside the collapse index (Co-index), defined as the degree of femoral head collapse relative to the contralateral healthy hip. Additional radiographic measurements analyzed included Reimer's migration index (RMI), the ellipsoidal index, the intraphyseal angle, and the presence of a double ossification nucleus. The correlation between these radiographic findings and final outcomes, as determined by the Stulberg classification and the sphericity deviation score (SDS), was evaluated.
Results:
Of the 142 hips analyzed in 104 patients, 36% progressed to Stulberg grades III to V, with a mean SDS of 40.0. The entire cohort included 16 Herring A hips, 88 Herring B hips, and 38 Herring C hips, with a mean Co-index was 11.7% (range: 0% to 36%) and mean RMI of 16.2% (±8.35%). Final femoral head asphericity followed a consistent process of ovalization, characterized by the presence of physeal angulation (79.5%), a double ossification nucleus (89%), and a progressive increase in the ellipsoidal index (1±0.89) in hips with Stulberg grades III to V.
Conclusions:
Early-onset LCPD does not guarantee favorable long-term outcomes, with one-third of cases resulting in final femoral head asphericity. This asphericity can be predicted by the progressive development of the ovalization process.
More Related Videos
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
08:40Author Spotlight: A Novel 3D-Printed Titanium Implant for Minimally Invasive Treatment of Hip Dysplasia in Young Dogs
Published on: April 19, 2024
Related Concept Videos
01:09Changes in the Appendicular Skeleton with Age
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...