Urinary excretion of deoxypyridinoline in Perthes' disease: a prospective, controlled comparative study in 83 children

The epidemiology and demographics of legg-calvé-perthes' disease

The etiology of Legg-Calvé-Perthes' disease (LCPD) is unknown. There are many insights however from epidemiologic/demographic information. A systematic medical literature review regarding LCPD was performed. The incidence ranges from 0.4/100,000 to 29.0/100,000 children <15 years of age. There is significant variability in incidence within racial groups and is frequently higher in lower socioeconomic classes. The typical age at presentation ranges from 4 to 8 years (average 6.5 years), except for children from the Indian subcontinent (average 9.5 years). There is a mild familial component. The children demonstrate impaired growth in height, skeletal age, and birth weight. This impaired growth coincides with an age appropriate reduced somatomedin A activity and decreased levels of IGF. LCPD can be associated with abnormalities in the coagulation cascade, including an increase in factor V Leiden mutation, low levels of protein C and/or S, and decreased antithrombin activity. There is decreased turnover in type I collagen and synthesis of type III collagen, as well as reduced levels of urinary glycosaminoglycans in the active phases of the disorder. Subtle abnormalities in the opposite hip and other minor/major congenital defects are reported. Children with LCPD are active and score abnormally in certain standardized psychological tests.

Perthes disease: current principles of diagnosis and treatment

BACKGROUND

Because the course of Legg-Calvé-Perthes disease (LCPD) is highly variable, its appropriate diagnostic evaluation and treatment are still debated.

METHODS

The authors selectively review the literature, present their own study findings, and discuss the guidelines of the German Society for Orthopedics and Orthopedic Surgery.

RESULTS

The main prognostic factors are the patient's age at the onset of the disease, the degree of limitation of range of motion, the extent of involvement of the femoral epiphysis, and any additional radiographic "head-at-risk" signs. Depending on the severity of the disease, the treatment options range from observation and frequent follow-up to reconstructive hip surgery. The goal of all treatments is to prevent a prearthrotic deformity and the ensuing premature coxarthrosis. This goal is best met by adherence to the principle of containment, i.e., the maintenance or restoration of joint congruence while biological plasticity is still present.

CONCLUSIONS

In view of the variable course of LCPD, the proper course of treatment must be determined individually in each case. Every child with LCPD must receive individually adapted treatment and continued follow-up into adulthood.