Materiały źródłowe

• #1 Long-term prognosis of Legg-Calvé-Perthes disease: a meta-analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10399117/

  In the literature, long-term prognosis of Legg-Calv-Perthes disease (LCPD) means prognosis for secondary osteoarthritis of the hip joint or leg-length inequality and its consequences. […] The long-term natural history of LCPD is not known. […] In spite of deformity, most patients do well in early adulthood. […] Radiographic and clinical osteoarthritis is increased in 20-year to 40-year follow-ups and degenerative joint disease develops in the majority of patients by the sixth or seventh decade of life. […] The only evidence-based factors that are of prognostic importance in the long-term are age of the patient at the onset of the disease and shape of the femoral head at skeletal maturity.

• #2 Imaging of Legg-Calve-Perthes Disease in Children | SpringerLink

  https://link.springer.com/10.1007/978-3-030-38095-3_83-1

  LeggCalvPerthes (LCP) disease, sometimes shortened and referred to as Perthes disease, represents idiopathic necrosis of the proximal femoral epiphysis in skeletally immature children. […] In most cases symptoms improve or resolve in childhood and prognosis is good in early adulthood, but increased incidence of hip osteoarthritis and need for hip replacement is noted in adulthood. […] Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes disease. J Bone Joint Surg. 2008;90-B(10). […] Cheng JC, Lam TP, Ng BK. Prognosis and prognostic factors of Legg-Calve-Perthes disease. J Pediatr Orthop. 2011;31. […] Rampal V. Legg-Calve-Perthes disease: classifications and prognostic factors. Clin Cases Miner Bone Metabol. 2017;14(1). […] Wiig O, Huhnstock S, Terjesen T, Pripp AH, Svenningsen S. The outcome and prognostic factors in children with bilateral Perthes disease. Bone Joint J. 2016;98-B(4).

• #2 Evolution in diagnosis and treatment of Legg-Calve-Perthes disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4151449/

  The most important determinant of long-term outcome is the femoral head shape. Extrusion of the head is the only factor that determines future degenerative arthritis and influences on treatment options. In children older than eight years, extrusion of the femoral head out of the acetabulum should be addressed to obtain containment. […] In the absence of lateral extrusion, most of the studies proved spontaneous healing without remaining functional impairment. […] Rosenfeld showed more than 80% favorable results in affected children less than six years old. […] Also Canaves et al. confirmed the good results with children less than six years of age. On the other hand, in severe cases, the prognosis did not differ between operative and non-operative treatment. […] A modified classification of lateral pillar also has been described by Lee et al., in which they classified type C into C1 and C2. Based on the Stulberg classification, they showed that the results of C1 were significantly better than C2. This modified classification has a significant value in predicting the outcome of LCPD.

• #3 Legg-Calve-Perthes disease: Impact of prognostic criteria on management plan – Journal of Musculoskeletal Surgery and Research

  https://journalmsr.com/legg-calve-perthes-disease-impact-of-prognostic-criteria-on-management-plan/

  Legg-Calve-Perthes disease (LCPD) is an idiopathic self-limited condition resulting from interruption of the blood supply of the femoral head in children. […] To predict the outcome and decide on the suitable management, a classification with prognostic characteristics should be helpful. The overall prognosis depends on the femoral head congruity with the acetabulum at maturity that will directly influence the occurrence of osteoarthritis. […] A favorable outcome is expected in 85% of patients. The outcome is almost always unfavorable in the very severe cases of LCPD. […] The Stulberg classification remains the standard reference for the assessment of prognosis and outcome at skeletal maturity. […] LCPD with early onset is expected to have a favorable outcome and rarely requires surgical intervention. The extent of femoral head involvement alone is not an indication for operative treatment. Surgery should be reserved for children of older age with loss of femoral head containment.

• #3

  https://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease

  Legg-Calve-Perthes Disease is an idiopathic avascular necrosis of the proximal femoral epiphysis in children. […] Treatment is typically observation in children less than 8 years of age, and femoral and/or pelvic osteotomy in children greater than 8 years of age. […] Lateral Pillar Classification has best agreement and is most predictive. […] Designed to provide prognostic information. […] Good outcomes correlate with a spherical femoral head. […] Good outcomes associated with lateral pillar A and Catterall I groups. […] Children with lateral pillar A and those with B under 8 years did well regardless of treatment. […] Large recent studies show improved outcomes with surgery for lateral pillar B and B/C in children 8 years (bone age 6 years). […] Studies suggest earlier surgery before femoral head deformity develops may be best.

• #4 Evolution in diagnosis and treatment of Legg-Calve-Perthes disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4151449/

  One other major complication of LCPD is trochanteric overgrowth. Kitoh et al. showed that there is a significant correlation between trochanteric overgrowth and the Stulberg classification at maturity. The only significant predictor of trochanteric overgrowth was the lateral pillar height with much greater risk of trochanteric overgrowth development in type C (44%) rather than types B and B/C (10%). […] One other complication of LCPD is leg length discrepancy (LLD). The most important predictor of LLD is the extent of lateral pillar involvement. It is the only predictor of LLD and no other factor including age, sex, and treatment modality is correlated with LLD at skeletal maturity. […] The reviewed studies showed three factors influencing the results in patients with LCPD including the age at onset, severity of the femoral head involvement, and the type of treatment. Patients over eight years old benefit from surgical intervention, whereas children less than six years of age often have a good prognosis, except in the group with lateral pillar type C involvement of the head.

• #5 Legg-Calve-Perthes Disease: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/826935-overview

  The long-term prognosis is related to the potential for osteoarthritis of the hip as an adult. It is worse for patients with metaphyseal defects, those in whom the disease develops late in childhood (age 10 y), and those who have more complex involvement of the femoral head with residual deformity; degenerative arthritis occurs in nearly 100% of these patients. This rate is in comparison to patients who are younger than 5 years when the problem develops; the incidence of degenerative arthritis is negligible in this younger population. […] The results of one small retrospective study found that total hip replacement can be considered a possible option for patients who had LCPD in childhood. Although a high rate of neurologic complications was noted, these were possibly related to inadequate soft-tissue release or excessive limb-lengthening.

• #6 Evolution in diagnosis and treatment of Legg-Calve-Perthes disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4151449/

  Other meta-analysis studies showed that the probability of developing the spherical head is more likely with operative rather than non-operative treatments in children older than six years. However, in children younger than six, operative and non-operative treatments did not yield any difference in prognosis and both resulted in good outcomes. […] Herring et al. in a prospective multicenter study concluded that the lateral pillar classification and age at the time of onset of the disease strongly correlate with the outcome in patients with LCPD. These two factors (age and lateral pillar classification) can be used to decide on operative versus non-operative treatments.

• #7 Legg-Calve-Perthes Disease | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/legg-calve-perthes-disease

  Legg-Calve-Perthes disease is a childhood femoral head ischemia of unknown etiology that may lead to permanent hip deformity. […] The Catterall and Lateral Pillar radiographic classifications estimate severity of involvement and offer general guidelines for prognosis, with better outcomes typically occurring in those with less severe involvement. […] Clinical severity, prognosis, and outcome are largely based on radiologic classification systems that employ standard AP and frog-leg lateral pelvis radiographs. […] Prognosis is judged by the risk of long-term hip arthritis, which is correlated to the Stulberg classification for radiographic morphology of the residual LCPD hip. […] Patients with onset after 11 years or lateral pillar class C have been considered to have a poor prognosis no matter the treatment type.

• #8 Confirmation of the Early Prognostic Value of Bone Scanning and Pinhole Imaging of the Hip in Legg-Calvé-Perthes Disease | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/44/11/1761

  In about half of all patients with Legg-Calv-Perthes disease (LCP), severe hip disorders that could be prevented by early surgery will develop. […] The positive predictive value of the scintigraphic classification proposed by Conways group was 97% for the B pathway (absence of lateral column formation) and 85% for the A pathway (presence of lateral column formation). […] The hyperactivity of the metaphyseal growth plates was a sign of poor prognosis. […] This study confirms the high prognostic value of bone scanning in LCP as reported by Conways group not only in terms of the accuracy of the classification but also in terms of the short time in which the prognostic information can be obtained. […] The A pathway is associated with a good final outcome. The B pathway is associated with a poorer functional prognosis because of the extent of the initial necrosis and the prolonged interval required for healing.

• #9 Confirmation of the Early Prognostic Value of Bone Scanning and Pinhole Imaging of the Hip in Legg-Calvé-Perthes Disease | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/44/11/1761

  The prognosis of LCP disease is related to the extent of the initial necrosis. […] Without specific treatment, severe hip disorders such as arthritis and severe osseous destruction will develop later in about half the patients with LCP disease. […] The absence of bone uptake on the proximal femoral epiphysis after 5 mo or metaphyseal hyperactivity is highly correlated with severe forms. […] The hyperactivity of the metaphyseal growth plates, when observed, is an additional sign predictive of a poor final outcome.

• #10 A retrospective study describing the acetabular consequences of Legg- Calve-Perthes disease | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-07852-w

  Examining the results presented in Table 2, it is evident that there are no statistically significant differences, given that the p-value is greater than 0.05, except for the grades and ADR. This implies that the null hypothesis is accepted for the first three parameters in the table namely, the ilioischial angle, obturator index, and Sharp angle have independent values concerning the assigned Stulbergs grade of the affected hips. On the other hand, the acetabular width-to-depth ratio (ADR) exhibits statistical significance less than 0.05. Consequently, the values of this variable fluctuate concurrently with the Stulbergs classification, suggesting prognostic value in the progression of LCPD. […] Our study evaluates pelvic parameters in Perthes disease, focusing on their possible prognostic value rather than surgical treatments.

• #11 A retrospective study describing the acetabular consequences of Legg- Calve-Perthes disease | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-024-07852-w

  However, concerning the significance of these measurements and their impact on the disease prognosis, only the ADR has demonstrated a correlation with the final Stulbergs classification. We believe that these results underscore the importance of a comprehensive approach to LCPD management, incorporating detailed anatomical assessments to inform treatment strategies and improve patient outcomes. In particular, our study highlights the prognostic significance of pelvic parameters. By integrating these measurements into prognostic models, clinicians can better predict disease outcomes and adjust treatment strategies accordingly. This approach might help in identifying patients at higher risk of poor outcomes and in intensifying monitoring and intervention efforts for these individuals.

• #12 Mid–Long-Term Outcomes of Surgical Treatment of Legg-Calvè-Perthes Disease: A Systematic Review

  https://www.mdpi.com/2227-9067/9/8/1121

  Surgical treatment in patients older than 6 years has excellent results in Herring B and B/C hips and poor results in Herring C hips, with a slight advantage for patients between 6 and 8 years old. […] Our analysis showed that the main prognostic factors for surgical outcome in patients with LCPD are the age at onset and the degree of initial disease severity. […] In conclusion, surgical treatment in patients aged more than 6 years was excellent in Herring B and B/C hips, with a high percentage of Stulberg I and II, poor results in Herring C hips, with a high percentage of Stulberg IV and V, with a slight advantage for patients aged between 6 and 8 years. Despite the lack of community guidelines, the early age at onset and, therefore, timely surgical treatment, in the initial phase of the fragmentation stage or before, which provides more time available for remodeling the femoral head before reaching skeletal maturity, the degree of initial disease severity and a suitable pre-operative range of motion remain the main indicators of surgical outcome to date.

• #13 Legg-Calve-Perthes Disease | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/legg-calve-perthes-disease

  However, evidence shows that radiographic stage is a stronger determinant of prognosis than age, with poor outcomes still occurring at this young age in Catterall class III/IV and lateral pillar class C hips. […] The classic studies by Herring et al suggested that surgical containment resulted in best outcomes in children over 8 years old with Catterall class III or IV, and lateral pillar class B or B/C border hips. […] However, recently it has been appreciated that containment treatment is most effective when initiated in the early stages of disease. […] Valgus intertrochanteric osteotomy has also been described as a treatment option in LCPD. […] These residual phase surgical options have been shown to improve patient outcomes via the Harris Hip Score.

• #14 Shelf osteotomy improves pain and stulberg outcome in Legg–Calve´– Perthes disease (LCPD) | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/133990-shelf-osteotomy-improves-pain-and-stulberg-outcome-in-legg-calve-perthes-disease-lcpd

  Shelf acetabuloplasty in early extruded femoral head and before extrusion improves and restores pain-free hip movements and improves sphericity of the femoral head and in turn stulberg functional outcome in children with perthes disease. […] The most important determining factors in the prognosis of the perthes disease are age, gender and the stage of the disease. But the femoral head deformity is the most crucial and determinant of outcome so the treatment of perthes depends predominantly on decreasing and or avoidance of Femoral head (FH) deformity to eliminate or decreasing degenerative hip joint disease. […] In our study, the femoral head subluxation improved from 1.45 to 1.22 following shelf acetabuloplasty also the size of the femoral head improved from 1.13 to 1.30 while shelf cap decreased and the coverage of the acetabulum improved.

• #15

  https://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease

  Poor outcome for lateral pillar C regardless of treatment. […] Important prognostic variables include younger age (bone age) 6 years at presentation is most important good prognostic indicator. […] Sphericity of femoral head and congruency at skeletal maturity (Stulberg classification) is also a factor. […] Variables of poor prognosis include female sex, decreased hip abduction (adduction contracture), heavy patient, longer duration from onset to completion of healing, stiffness with progressive loss of ROM, and Catterall „head at risk” signs. […] Long-term studies suggest that most patients do well until fifth or sixth decade of life. […] Approximately 1/2 of patients develop premature osteoarthritis secondary to an aspherical femoral head.

• #16 Imaging of Legg–Calvé–Perthes Disease in Children | SpringerLink

  https://link.springer.com/10.1007/978-3-030-89688-1_83

  LeggCalvPerthes (LCP) disease, sometimes shortened and referred to as Perthes disease, represents idiopathic necrosis of the proximal femoral epiphysis in skeletally immature children. […] In most cases symptoms improve or resolve in childhood and prognosis is good in early adulthood, but increased incidence of hip osteoarthritis and need for hip replacement is noted in adulthood. […] The long-term prognosis of Legg-Calv-Perthes disease: a historical prospective study with a median follow-up of forty one years. […] Prognosis and prognostic factors of Legg-Calve-Perthes disease. […] The outcome and prognostic factors in children with bilateral Perthes disease. […] Prognostic evaluation of Legg-Calv-Perthes disease by MRI. Part I: the role of physeal involvement. […] Prognostic evaluation of Legg-Calv-Perthes disease by MRI. Part II: pathomorphogenesis and new classification.

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