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Zhi X, Wu H, Xiang C, Wang J, Tan Y, Zeng C, Xu H, Canavese F. Incidence of total hip arthroplasty in patients with Legg-Calve-Perthes disease after conservative or surgical treatment: a meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:1449-1464. [PMID: 36928552 DOI: 10.1007/s00264-023-05770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to determine the incidence of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) treated conservatively or surgically and factors influencing the incidence of THA. METHODS Long-term follow-up studies on the conservative or surgical treatments of LCPD from 1950 to 2021 were conducted using six public databases. Articles were screened by two investigators (PRISMA guidelines), and the quality of the included publications (n = 27) was assessed (MINORS criteria). R version 4.2.1 was used for statistical analysis. RESULTS The overall incidences of THA were 6.8% and 5.14% in patients who were treated conservatively and surgically, respectively. At disease onset, the incidences of THA were 6.79% and 6.17% after conservative treatment and surgery in patients aged < seven years, respectively, and 16.97% and 3.61% in patients aged > seven years, respectively. The incidences of THA were 4.91%, 5.19%, and 23.18% in patients who were treated conservatively with ≤ 30, 30-40, and > 40 years of follow-up, respectively, and 3.68%, 3.11%, 9.66%, and 17.92% in patients who were treated surgically with ≤ ten, ten to 20, 20-40, and > 40 years of follow-up, respectively. In patients who received conservative treatment, the incidences of THA were 5.79% and 5.29% in patients with Stulberg I-II and III-V, respectively. In surgically treated patients, the incidence of THA was 0% in Stulberg I-II and 8% in Stulberg III-V. CONCLUSION Patients with LCPD had relatively low incidences of THA. The greater the age at disease onset and longer the follow-up, the higher the incidence of THA; however, the Stulberg classification was not directly associated with the incidence of THA.
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Affiliation(s)
- Xinwang Zhi
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China.,Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Huimei Wu
- School of Pediatrics, Guangzhou Medical University, Xinzao, Guangzhou, 510000, China
| | - Chenyu Xiang
- School of Pediatrics, Guangzhou Medical University, Xinzao, Guangzhou, 510000, China
| | - Jianqun Wang
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China
| | - Yeya Tan
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chun Zeng
- Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongwen Xu
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China.
| | - Federico Canavese
- Department of Pediatric Orthopedics, GuangZhou Women and Children's Medical Center, 9 Jinsui Road, Guangzhou, 510623, China. .,Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine, Jeanne de Flandre Hospital, Avenue Eugène-Avinée, 59000, Lille, France.
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Abstract
AIMS To identify a suite of the key physical, emotional, and social outcomes to be employed in clinical practice and research concerning Perthes' disease in children. METHODS The study follows the guidelines of the COMET-Initiative (Core Outcome Measures in Effectiveness Trials). A systematic review of the literature was performed to identify a list of outcomes reported in previous studies, which was supplemented by a qualitative study exploring the experiences of families affected by Perthes' disease. Collectively, these outcomes formed the basis of a Delphi survey (two rounds), where 18 patients with Perthes' disease, 46 parents, and 36 orthopaedic surgeons rated each outcome for importance. The International Perthes Study Group (IPSG) (Dallas, Texas, USA (October 2018)) discussed outcomes that failed to reach any consensus (either 'in' or 'out') before a final consensus meeting with representatives of surgeons, patients, and parents. RESULTS In total, 23 different outcome domains were identified from the systematic review, and a further ten from qualitative interviews. After round one of the Delphi survey, participants suggested five further outcome domains. A total of 38 outcomes were scored in round two of the Delphi. Among these, 16 outcomes were scored over the prespecified 70% threshold for importance (divided into six main categories: adverse events; life impact; resource use; pathophysiological manifestations; death; and technical considerations). Following the final consensus meeting, 14 outcomes were included in the final Core Outcome Set (COS). CONCLUSION Core Outcome Sets (COSs) are important to improve standardization of outcomes in clinical research and to aid communication between patients, clinicians, and funding bodies. The results of this study should be a catalyst to develop high-quality clinical research in order to determine the optimal treatments for children with Perthes' disease. Cite this article: Bone Joint J 2020;102-B(5):611-617.
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Affiliation(s)
- Donato G Leo
- School of Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Helen Jones
- School of Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Rebecca Murphy
- School of Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Tina Gambling
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Andrew F Long
- School of Healthcare, University of Leeds, Leeds, UK
| | - Jennifer Laine
- Gillette Children's Specialty Healthcare, St Paul, Minneapolis, USA, Minnesota, USA.,Executive Committee Member of the International Perthes Study Group (IPSG), Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, USA
| | - Daniel C Perry
- University of Liverpool, Liverpool, UK.,University of Oxford, Oxford, UK.,Alder Hey Hospital,Institute in the Park, Liverpool, UK
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Leo DG, Murphy R, Gambling T, Long A, Jones H, Perry DC. Perspectives on the Social, Physical, and Emotional Impact of Living With Perthes' Disease in Children and Their Family: A Mixed Methods Study. Glob Pediatr Health 2019; 6:2333794X19835235. [PMID: 30993152 PMCID: PMC6449807 DOI: 10.1177/2333794x19835235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/13/2018] [Accepted: 12/18/2018] [Indexed: 11/17/2022] Open
Abstract
Aim. To determine the social, physical, and emotional impact of
living with Perthes’ disease on affected children and their family (caregivers).
Patients and Methods. Through a mixed methods approach, we
interviewed 18 parents and explored the perspectives of 12 children affected by
Perthes’ disease (mean = 7.1 years, SD = ±4.1 years) using a survey tool.
Thematic analysis of parents’ interviews provided an insight into
disease-specific factors influencing patients and family’s daily life
activities. Using the childhood survey tool, good and bad day scores were
analyzed using MANOVA (multivariate analysis of variance).
Results. Thematic analysis of the parent interviews (main
themes n = 4) identified a marked effect of the disease on many facets of the
child’s life, particularly pain and the impact on sleep, play, and school
attendance. In addition, the interviews identified a negative effect on the
family life of the parents and siblings. Children indicated that activities of
daily living were affected even during “good days” (P <
.05), but pain was the key limiting factor. Conclusion.
Perthes’ disease negatively affects the social, physical, and emotional
well-being of children and their family. These findings provide outcome domains
that are important to measure in day-to-day care and add in-depth insight into
the challenges caused by this disease for health care professionals involved in
clinical management.
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Affiliation(s)
| | | | | | | | - Helen Jones
- Liverpool John Moores University,
Liverpool, UK
| | - Daniel C. Perry
- University of Liverpool, Liverpool,
UK
- Daniel C. Perry, University of Liverpool,
Alder Hey Hospital, Eaton Road, Liverpool, L12 2AP, UK.
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