Long-term prognosis of Legg-Calvé-Perthes disease: a meta-analysis.

In the literature, long-term prognosis of Legg-Calvé-Perthes disease (LCPD) means prognosis for secondary osteoarthritis of the hip joint or leg-length inequality and its consequences. Most studies show results after conservative treatment. 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 reported average shortening of the affected leg has usually been 1 to 1.5 cm. There are no thorough long-term reports on low back pain after LCPD. 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.

Prognosis after conservative and operative treatment in Perthes' disease.

The prognosis of Perthes' disease was studied after femoral intertrochanteric varus osteotomy in 112 patients (126 hips) and after conservative noncontainment treatment (Thomas splint) in 96 patients (106 hips). The radiographic results at or near skeletal maturity after containment treatment were good in 45%, fair in 21%, and poor in 34% of the hips. The figures after noncontainment treatment were 21%, 18% and 61%, respectively. The results support the idea that containment of the femoral head in the acetabulum should form the basis of treatment for Perthes' disease. It was very difficult to delineate signs for good prognosis; age at onset of the disease and a good containment three months postoperatively in the operatively treated group were the only signs with prognostic significance. In both groups, one fifth of the patients had an extremely poor outcome. Treatment other than varus osteotomy or noncontainment treatment should be considered in these patients.

Leg-length inequality and low-back pain after Perthes' disease: a 28-47-year follow-up of 96 patients.

A follow-up of 96 patients with Perthes' disease was made 28-47 years after onset of the disease. We paid special attention to leg-length inequality and its consequences and low-back disability. Leg-length inequality was a common finding, but low-back pain was not a significant problem. Leg-length inequality and lumbar scoliosis correlated poorly with low-back disorders. Degeneration of the lumbar spine was the only factor that correlated well with low-back pain.

Prognosis in Perthes' disease after noncontainment treatment. 106 hips followed for 28-47 years.

The results in 96 patients (106 hips) with Perthes' disease who had had conservative noncontainment treatment were studied after 35 (28-47) years. At skeletal maturity, the radiographic result was poor in 65 hips. At the average age of 43 years, radiographic signs of arthrosis were found in 48 patients (51 hips); 5 patients had had hip replacement and 13 patients had symptoms justifying that procedure. At early phases of the disease, radiographs showed biocompartmentalization of the acetabulum in 24 percent of the hips, but the acetabulum normalized in the majority. There was no difference in long-term prognosis between Catterall's Groups III and IV; two or more signs of head-at-risk were not of prognostic value. The patients' age at diagnosis and the shape of the femoral head at skeletal maturity were the most reliable prognostic factors.

Poor prognosis in atypical Perthes' disease. Radiographic analysis of 19 hips after 35 years.

We analyzed clinical and radiographic long-term results in 96 patients (106 hips) with Perthes' disease 35 years after nonoperative treatment. 19 hips in 17 patients had early radiographic signs indicating atypically severe course of the disease and poor prognosis. None of them was radiographically good at skeletal maturity; 2 cases were fair and 17 poor. At the final follow-up 12 hips had radiographic arthrosis.

Intertrochanteric varus osteotomy for Perthes' disease. Radiographic changes after 2-16-year follow-up of 126 hips.

We analyzed various prognostic factors in 112 children operated on for Perthes' disease (Catterall's groups II-IV); special attention was paid to acetabular changes and postoperative containment. The radiographic results of 126 intertrochanteric femoral varus osteotomies were analyzed 2-16 years postoperatively. Catterall's grouping or head-at-risk phenomenon, bicompartmentalization of the acetabulum, and preoperative subluxation of the femoral head did not correlate with the result. The result was worse in cases operated on in the healing phase of the disease and in patients operated on at the age of 9 years or older. The strongest prognostic factor was containment of the femoral head after osteotomy.

Premedication and short term complications in iohexol discography.

In 52 patients 0.5-3.0 ml of iohexol, 180 mg/ml, was injected using lateral injection technique and fluoroscopy control. A total of 146 lumbar discs using local anaesthesia was injected. Two types of premedication were used; either diazepam alone or diazepam in combination with pethidine and glycopyrronium bromide. There was no difference in the discography injection pain between the groups (X2 = 0.774, P greater than 0.05]. During discography, some patients had nausea (2%), convulsions (4%), back pain (6%) and hypotension (10%), but no allergic reactions were seen. This suggests that these immediate reactions are more related to the procedure itself than to the non-ionic ratio 3.0 iohexol contrast medium. More troublesome iatrogenic complications were seen the day after the discography in the form of severe headache (10%) probably related to liquor leakage, and increasing low back pain (81%). The latter may be caused by local haematoma or chemical irritation from iohexol. Patients with no pain during injection had a relatively slight need for analgesics (Somer's D = -0.196, P less than 0.05).

[Early signs of poor prognosis in Legg-Perthes-Calve disease treated by femoral varus osteotomy]. / Signes précoces de mauvais pronostic dans la maladie de Legg-Perthes-Calvé traitée par ostéotomie fémorale de varisation.

A total of 126 Perthes diseases (112 patients) were studied. The treatment comprised intertrochanteric femoral varus osteotomy in every patient. In 20 patients (25 hips), the course of the disease was more severe than expected. The early radiological criteria for this severe course were: 1. Lateral calcification extending far laterally towards the greater trochanter, 2. Deformation and widening of the femoral head before the fragmentation phase, 3. The Saturn phenomenon; a sclerotic epiphysis surrounded by a ring of looser bony tissue, 4. Deformation and widening of the femoral neck at the initial phase of the disease, 5. Early wide sclerotic changes in the metaphysis. The overall results were poor. Two hips obtained a fair and 23 poor results. These described radiological changes are readily recognized at early phase of Perthes disease and indicate poor prognosis. In these cases varus osteotomy gave unsatisfactory results which means that other type of treatment in these patients should be considered.

Clinical relevance of discography combined with CT scanning. A study of 100 patients.

Two different classifications of discograms have been used in a prospective study of 279 injected discs in 100 patients. The five-stage classification of Adams, Dolan and Hutton (1986) showed increased degeneration in the lower lumbar discs and more degenerative changes in men than in women. Exact reproduction of the patient's pain on injection was more common in fissured or ruptured discs than in less degenerate discs, with 81% sensitivity and 64% specificity of the discogram for pain. The additional information obtained by comparing computerised tomography (CT) with discograms was minimal. Discography was found to be useful in the evaluation of chronic low back pain in patients whose ordinary CT scans, myelograms and flexion-extension radiographs were normal. In spondylolysis and spondylolisthesis, discography can disclose whether fusion needs to be extended above the lytic level, and it may show if the pain in patients who have had posterolateral fusion is discogenic. Thus, discography gives information which is useful in deciding whether to operate on patients with chronic low back pain.

A new design for a liquid scintillation counter for micro samples using a flat-bed geometry.

A new design for a liquid scintillation counter based on a flat-bed geometry is described. Micro-samples are dried or filtered onto transfer membranes or glass fibre filters in a 6 X 16 matrix, compatible with 96-well micro-titration plate filtration assays of labelled cells. A prototype counter without lead shielding had low background countrates (2-3 cpm for 3H) giving a figure of merit of 1325 (and 1292 for 14C). Only 5-15 ml of scintillant/96 samples are required and thus the volume of radioactive waste is low.

Microprocessor crosstalk correction in multiple-detector gamma counters.

A method for compensating for crosstalk between nuclear counters and its application to a multidetector gamma counter is described. The standardisation procedure employed measures the relative efficiency of each detector for a sample within that detector and for the same detector when the sample is located in each of the other detectors. Results with a 12-element detector system show that the stored calibration data obtained in this way can be applied successfully to correct the observed count rates for crosstalk as well as detector sensitivity differences when using gamma emitters having energies up to 1.3 MeV.