Comparison of the results from simple radiography, from before to after Salter osteotomy, in patients with Legg-Calvé-Perthes disease

Management of Patients With Legg-Calvé-Perthes Disease at a Single Center in Jeddah, Saudi Arabia

Background: Legg-Calvé-Perthes disease (LCPD) is an idiopathic pediatric hip disorder associated with avascular necrosis of the femoral head. Although there is no standardized and optimal treatment protocol for patients with LCPD, there are three primary treatment strategies: symptomatic treatment, nonsurgical containment using orthotic devices, and surgical containment.

Objective: This study aimed to describe the demographic characteristics, management and outcome of pediatric patients with LCPD at our center between 2005 and 2015.

Material and Methods: In this retrospective study, 23 patients with LCPD who represented all patients with LCPD treated at King Abdul-Aziz Medical City, Jeddah, Saudi Arabia between 2005 and 2015 were enrolled. Their demographic and clinical characteristics, treatment methods, and outcomes were evaluated.

Results: Descriptive statistics showed that most of the patients were males (87.0%), with a mean age of 7.1±2.4 years. None of the patients had a family history of LCPD. Approximately two-thirds of the patients reported hip pain as the chief concern. LCPD was observed in the left hip in 60.9% of patients, the right hip in 21.7% of patients, and both hips in 17.4% of patients. Approximately half of the patients (55.3%) were treated with physiotherapy, and 10.6% were treated with orthotics. Despite that, 10 patients (43.4%) required surgical management after the conservative approach, and six of them underwent pelvic Salter innominate osteotomy.

Conclusion: These results highlight the experience of a single center in managing patients with LCPD. Treatment was different based on patient age; non-surgical treatment, mainly physiotherapy, was predominant in younger children. However, regardless of the type of treatment, the earlier interventions have proven to provide better outcomes in patients with this health condition.

Legg-Calvé-Perthes disease: classifications and prognostic factors

INTRODUCTION

Legg-Calvé-Perthes Disease (LCPD) represents idiopathic avascular necrosis of femoral head in pediatric population. Indications for treatment depend mostly on prognosis about femoral head sphericity and hip congruence at the end of growth. The aim of this review is to highline prognostic factors of LCPD.

METHODS

Bibliographic search in PubMed allowed selection of 33 articles concerning prognostic factors and/or classification of LCPD.

CONCLUSION

Clinical factors of poor prognosis are overweight, female sex, age exceeding 6 years old, and lack of hip abduction. Radiologically, Herring's classification is consensual because of its high prognostic value and very good reproducibility. The other signs of femoral head "at-risk" and the assessment of the reduction in abduction of the femoral head in the acetabulum are also prognostic of late evolution. MRI seems to be a future tool in assessing the fate of hips in LCPD. It is likely that a better understanding of LCPD etiology would precise the prognosis of this disease.