Treatment Complications of Legg-Calvé-Perthes Disease

Osman Nuri ÖZYALVAÇa , Hakan ÖMEROĞLUb

aUniversity of Health Sciences Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Türkiye
bUfuk University Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Türkiye

ABSTRACT
Legg-Calvé-Perthes Disease (LCPD), a rare idiopathic avascular necrosis affecting the proximal femoral epiphysis in children, presents challenges in pediatric orthopedics. Though self-resolution is common, the resulting deformities and complications necessitate vigilant management. Because this disease progresses with sequels, it becomes challenging to distinguish between the problems inherent in its natural course and the complications arising from treatment. Managing complications requires an understanding of various treatment methods, their indications, and potential outcomes. Balancing optimal alignment and containment while monitoring for post-operative issues ensures the best outcomes for children with LCPD. A multidisciplinary approach involving clinical expertise, advanced imaging, and surgical precision is essential in effectively managing this complex disease.
Keywords: Legg-Calvé-Perthes disease; proximal femur deformity; hinged abduction; proximal femur osteotomies; avascular necrosis

Referanslar

  1. Mose K, Hjorth L, Ulfeldt M, Christensen ER, Jensen A. Legg Calvé Perthes disease. The late occurence of coxarthrosis. Acta Orthop Scand Suppl. 1977;169:1-39. [Crossref]
  2. Herring JA, Williams JJ, Neustadt JN, Early JS. Evolution of femoral head deformity during the healing phase of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1993;13(1):41-5. [Crossref]  [PubMed]
  3. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112-20. [Crossref]  [PubMed]
  4. Sinigaglia R, Bundy A, Okoro T, Gigante C, Turra S. Is conservative treatment really effective for Legg-Calvé-Perthes disease? A critical review of the literature. Chir Narzadow Ruchu Ortop Pol. 2007;72(6):439-43.
  5. Leroux J, Abu Amara S, Lechevallier J. Legg-Calvé-Perthes disease. Orthop Traumatol Surg Res. 2018;104(1S):S107-S12. [Crossref]  [PubMed]
  6. Kim HK, Herring JA. Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am. 2011;42(3):285-95, v. [Crossref]  [PubMed]
  7. Larson AN, Sucato DJ, Herring JA, Adolfsen SE, Kelly DM, Martus JE, et al. A prospective multicenter study of Legg-Calvé-Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Joint Surg Am. 2012;94(7):584-92. [Crossref]  [PubMed]
  8. Reinker KA. Early diagnosis and treatment of hinge abduction in Legg-Perthes disease. J Pediatr Orthop. 1996;16(1):3-9. [Crossref]  [PubMed]
  9. Choi IH, Yoo WJ, Cho TJ, Moon HJ. Principles of treatment in late stages of Perthes disease. Orthop Clin North Am. 2011;42(3):341-8, vi. [Crossref]  [PubMed]
  10. Nakamura J, Kamegaya M, Saisu T, Kenmoku T, Takahashi K, Harada Y. Hip arthrography under general anesthesia to refine the definition of hinge abduction in Legg-Calvé-Perthes disease. J Pediatr Orthop. 2008;28(6):614-8. Erratum in: J Pediatr Orthop. 2013;33(7):774. [Crossref]  [PubMed]
  11. Yoo WJ, Choi IH, Cho TJ, Chung CY, Shin YW, Shin SJ. Shelf acetabuloplasty for children with Perthes' disease and reducible subluxation of the hip: prognostic factors related to hip remodelling. J Bone Joint Surg Br. 2009;91(10):1383-7. [Crossref]  [PubMed]
  12. Kamegaya M, Saisu T, Takazawa M, Nakamura J. Arthrographic indicators for decision making about femoral varus osteotomy in Legg-Calvé-Perthes disease. J Child Orthop. 2008;2(4):261-7. [Crossref]  [PubMed]  [PMC]
  13. Joseph B. Morphological changes in the acetabulum in Perthes' disease. J Bone Joint Surg Br. 1989;71(5):756-63. [Crossref]  [PubMed]
  14. Clohisy JC, Ross JR, North JD, Nepple JJ, Schoenecker PL. What are the factors associated with acetabular correction in Perthes-like hip deformities? Clin Orthop Relat Res. 2012;470(12):3439-45. [Crossref]  [PubMed]  [PMC]
  15. Sankar WN, Flynn JM. The development of acetabular retroversion in children with Legg-Calvé-Perthes disease. J Pediatr Orthop. 2008;28(4):440-3. [Crossref]  [PubMed]
  16. Kawahara S, Nakashima Y, Oketani H, Wada A, Fujii M, Yamamoto T, et al. High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-Calvé-Perthes disease. J Orthop Sci. 2012;17(3):226-32. [Crossref]  [PubMed]
  17. Kim YJ, Novais EN. Diagnosis and treatment of femoroacetabular impingement in Legg-Calvé-Perthes disease. J Pediatr Orthop. 2011;31(2 Suppl):S235-40. [Crossref]  [PubMed]
  18. Accadbled F, Pailhé R, Launay F, Nectoux E, Bonin N, Gicquel P; SOFCOT. "Femoroacetabular impingement". Legg-Calve-Perthes disease: from childhood to adulthood. Orthop Traumatol Surg Res. 2014;100(6):647-9. [Crossref]  [PubMed]
  19. Risto O, Sandquist S, Lind S, Madan S. Outcome after osteochondroplasty and relative neck lengthening for patients with healed Legg-Calvé-Perthes disease: a retrospective cohort study of patients with hip-deformities treated with osteochondroplasty and relative neck lengthening. Hip Int. 2021;31(3):417-423. [Crossref]  [PubMed]
  20. Zhang C, Li L, Forster BB, Kopec JA, Ratzlaff C, Halai L, et al. Femoroacetabular impingement and osteoarthritis of the hip. Can Fam Physician. 2015;61(12):1055-60.
  21. Rowe SM, Moon ES, Yoon TR, Jung ST, Lee KB, Lee JJ. Fate of the osteochondral fragments in osteochondritis dissecans after Legg-Calve-Perthes' disease. J Bone Joint Surg Br. 2002;84(7):1025-9. [Crossref]  [PubMed]
  22. Haas A. Umbau von Perthes'scher Krankheit in osteochondritis dissecans. zentralbl F Chir. 1937;64:2873-5.
  23. Roy DR. Arthroscopic findings of the hip in new onset hip pain in adolescents with previous Legg-Calve-Perthes disease. J Pediatr Orthop B. 2005;14(3):151-5. [Crossref]  [PubMed]
  24. Girard J, Roumazeille T, Sakr M, Migaud H. Osteochondral mosaicplasty of the femoral head. Hip Int. 2011;21(5):542-8. [Crossref]  [PubMed]
  25. Moghadam MH, Moradi A, Omidi-Kashani F. Clinical outcome of femoral osteotomy in patients with legg-calve'-perthes disease. Arch Bone Jt Surg. 2013;1(2):90-3.
  26. Goyal T, Barik S, Gupta T. Hip Arthroscopy for Sequelae of Legg-Calve-Perthes Disease: A Systematic Review. Hip Pelvis. 2021;33(1):3-10. [Crossref]  [PubMed]  [PMC]
  27. Yoo WJ, Choi IH, Moon HJ, Chang S, Cho TJ, Choi YH, et al. Valgus femoral osteotomy for noncontainable Perthes hips: prognostic factors of remodeling. J Pediatr Orthop. 2013;33(6):650-5. [Crossref]  [PubMed]
  28. Aguado-Maestro I, Abril JC, Bañuelos Diaz A, García Alonso M. Hip arthrodiastasis in Legg-Calvé-Perthes disease. Rev Esp Cir Ortop Traumatol. 2016;60(4):243-50. English, Spanish. [Crossref]  [PubMed]