Legg-Calvé-Perthes disease overview.

BACKGROUND: Legg-Calvé-Perthes Disease (LCPD) is a necrosis of the femoral head which affects the range of motion of the hips. Its incidence is variable, ranging from 0.4/100,000 to 29.0/ 100,000 children. Although LCPD was first described in the beginning of the past century, limited is known about its etiology. Our objective is to describe the main areas of interest in Legg-Calve-Perthes disease. METHODS: A review of the literature regarding LCPD etiology was performed, considering the following inclusion criteria: Studies reporting clinical or preclinical results. The research group carried out a filtered search on the PubMed and Science Direct databases. To maximize the suitability of the search results, we combined the terms ''Perthes disease" OR "LCPD" OR "children avascular femoral head necrosis" with "diagnostic" OR "treatment" OR "etiology" as either key words or MeSH terms. RESULTS: In this article been described some areas of interest in LCPD, we include topics such as: history, incidence, pathogenesis, diagnosis, treatment and possible etiology, since LCPD has an unknown etiology. CONCLUSIONS: This review suggests that LCPD has a multifactorial etiology where environmental, metabolic and genetic agents could be involved.

Hip Morphology in Early-stage LCPD: Is There an Argument for Anatomic-specific Containment?

BACKGROUND: Early containment surgery has become increasingly popular in Legg-Calvé-Perthes Disease (LCPD), especially for older children. These procedures treat the proximal femur, the acetabulum, or both, and most surgeons endorse the same surgical option regardless of an individual patient's anatomy. This "one-surgery-fits-all" approach fails to consider potential variations in baseline anatomy that may make one option more sensible than another. We sought to describe hip morphology in a large series of children with newly diagnosed LCPD, hypothesizing that variation in anatomy may support the concept of anatomic-specific containment. METHODS: A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 at diagnosis. To assess anatomy before significant morphologic changes secondary to the disease itself, only patients in Waldenström stages IA/IB were included. Standard hip radiographic measurements including acetabular index, lateral center-edge angle, proximal femoral neck-shaft angle (NSA), articulotrochanteric quartiles, and extrusion index (EI) were made on printed anteroposterior pelvis radiographs. Age-specific percentiles were calculated for these measures using published norms. Significant outliers (≤10th/≥90th percentile) were reported where applicable. RESULTS: A total of 168 patients with mean age at diagnosis of 8.0±1.3 years met inclusion criteria (81.5% male). Mean acetabular index for the entire cohort was 16.8±4.1 degrees; 58 hips (34.5%) were significantly dysplastic compared with normative data. Mean lateral center-edge angle was 15.9±5.2 degrees at diagnosis; 110 (65.5%) were ≤10th percentile indicating dysplasia (by this metric). Mean NSA overall was 136.5±7.0 degrees. Fifty-one (30.4%) and 20 (11.9%) hips were significantly varus (≤10th percentile) or valgus (≥90th percentile), respectively. Thirty-five hips (20.8%) were the third articulo-trochanteric quartiles or higher suggesting a higher-riding trochanter at baseline. Mean EI was 15.5%±9.0%, while 63 patients (37.5%) had an EI ≥20%. CONCLUSIONS: The present study finds significant variation in baseline anatomy in children with early-stage LCPD, including a high prevalence of coexisting acetabular dysplasia as well as high/low NSAs. These variations suggest that the "one-surgery-fits-all" approach may lack specificity for a particular patient; a potentially wiser option may be an anatomic-specific containment operation (eg, acetabular-sided osteotomy for coexisting dysplasia, varus femoral osteotomy for valgus NSA). LEVEL OF EVIDENCE: Level IV.

The possible origin of Legg-Calvé-Perthes disease / El posible origen de la enfermedad de Legg-Calvé-Perthes

Legg-Calvé-Perthes disease (LCPD) is a childhood orthopedic pathology that affects the development of the hip. It is a rare disease with a huge variation in annual incidence. It occurs approximately five times more often in boys than in girls. The objective of this article was to formulate a hypothesis about the possible origin of LCPD, from the paleopathological findings of this disease reported until 2017, and to highlight the importance of anthropology, history, paleontology and paleopathology to the study of the origins of disease. By using eight web-based search engines, we performed a review of articles focused on the history, genetics and paleopathological findings of LCPD; we evaluated in total 133 articles published between 1910 and 2017. Out of these, 20 articles belonging to the same publication period were included in this analysis. LCPD was described for the first time approximately 100 years ago and without knowing it was a new disease. In the last years, human remains have been found in which LCPD has been identified, providing relevant information about the origin of this pathology. These data and their historical context can be a basis to propose the Asian continent as the site of origin of LCPD; however, new anthropological, genetic and paleopathological studies are needed to reinforce or refute this hypothesis.

La enfermedad de Legg-Calvé-Perthes (ELCP) es una afección ortopédica infantil que repercute en el desarrollo de la cadera. Es una enfermedad rara con incidencia anual variable. Es aproximadamente cinco veces más frecuente en niños que en niñas. El objetivo de este artículo fue formular una hipótesis acerca del posible origen de la ELCP a partir de hallazgos paleopatológicos reportados hasta el año 2017, además de resaltar la importancia que ofrecen la antropología, la historia, la paleontología y la paleopatología para el estudio del origen de las enfermedades. Mediante ocho buscadores se hizo una revisión de artículos referentes a la historia, la genética y los hallazgos paleopatológicos de la ELCP; se evaluaron un total de 133 artículos publicados entre 1910 y 2017. De ellos, fueron incluidos en este análisis 20 artículos que abarcaron el mismo periodo de publicación. La ELCP comenzó a describirse hace poco más de 100 años y sin el conocimiento de que se trataba de una entidad nueva. En los últimos años se han encontrado restos humanos en los que se ha identificado la ELCP, lo cual ha brindado información relevante respecto al origen de este padecimiento. Estos datos y su contexto histórico pueden ser fundamentos para plantear al continente asiático como el sitio de origen de la ELCP; sin embargo, se requiere de nuevos estudios antropológicos, genéticos y paleopatológicos para reforzar o refutar esta hipótesis.

MRI abnormalities of the acetabular labrum and articular cartilage are common in healed Legg-Calvé-Perthes disease with residual deformities of the hip.

BACKGROUND: Varying degrees of femoral deformity may result as Legg-Calvé-Perthes disease heals. Our aims were to investigate the prevalence of abnormalities of the acetabular labrum and cartilage, using noncontrast magnetic resonance imaging, and to correlate the findings with radiographic deformities that may exist after the healing of Legg-Calvé-Perthes disease. METHODS: In a sample of ninety-nine patients with healed Legg-Calvé-Perthes disease, anteroposterior and lateral radiographs were used to assess the Stulberg classification, femoral head size and sphericity, femoral neck morphology, and acetabular version. A subgroup of fifty-four patients (fifty-nine hips) underwent noncontrast magnetic resonance imaging of the hip an average of eight years after disease onset. The acetabular labrum was evaluated according to a modified classification system, and the acetabular cartilage was evaluated for the presence of delamination and defects. The association among abnormalities of the acetabular labrum, articular cartilage, and radiographic deformities was assessed. RESULTS: Abnormalities of the acetabular labrum and cartilage were found on magnetic resonance imaging scans in 75% and 47% of the hips, respectively. An alpha angle of ≥55° was the deformity most significantly associated with labral and cartilage abnormalities, followed by coxa brevis. Coxa magna and a higher greater trochanter showed a significant association with labral abnormalities only. Acetabular retroversion showed an increased risk for labral abnormalities when the alpha angle was normal. When deformities coexisted, the alpha angle showed the greatest relative risk for abnormality. CONCLUSIONS: On the basis of magnetic resonance imaging evaluation of the hip, labral and cartilage abnormalities were a common finding in patients with healed Legg-Calvé-Perthes disease. Our results suggest that hip deformities are significantly associated with labral and cartilage abnormalities on magnetic resonance imaging, and the main predisposing factor was the asphericity of the femoral head with a reduced femoral head-neck offset.

[Radiologic correlation between the lateral pillar classification stages and the presence of femoroacetabular impingement in patients with Legg-Calvé-Perthes disease]. / Correlación radiológica entre los estadios de la clasificación del pilar lateral y la presencia de pinzamiento femoroacetabular en pacientes con enfermedad de Legg-Calvé-Perthes.

BACKGROUND: Lateral pillar classification has proven to be useful for the prognosis and treatment of patients with Legg-Calvé-Perthes disease. Most patients progress to skeletal maturity with some kind of morphologic alteration. Femoroacetabular impingement is a condition that results in early osteoarthrosis. The objective of this study was to determine whether there is a correlation between the initial lateral pillar classification and the presence of final femoroacetabular impingement. MATERIAL AND METHODS: A retrospective review of 61 patients with Legg-Calvé-Perthes disease was conducted (68 hips); they were classified into three groups according to the lateral pillar classification. At the time of skeletal maturity the radiographic presence of femoroacetabular impingement was determined and the correlation between both variables was analyzed. RESULTS: The use of the lateral pillar classification resulted in seven hips considered as type A, 37 as type B, and 24 as type C. Three of the type A hips had radiographic findings of cam femoroacetabular impingement, three of pincer femoroacetabular impingement, and one of mixed femoroacetabular impingement. Among type B hips, radiographic data of cam femorocetabular impingement were found in17, of pincer femoroacetabular impingement in 12, and of mixed femoroacetabular impingement in 10. Twenty-three of the type C hips had radiographic data of cam femoroacetabular impingement, 15 of pincer femoroacetabular impingement, and 15 of mixed femoroacetabular impingement. CONCLUSION: Patients with Legg-Calvé-Perthes disease have a directly proportional relationship between the initial lateral pillar classification and subsequent femoroacetabular impingement.

Perthes tratamiento ortopédico. Nuestra experiencia / Perthes orthopaedic treatment. Our experience

Clasificación de Herring (AU)

Clasificación de Stulberg (AU)

Perthes tratamiento ortopédico. Nuestra experiencia / Perthes orthopaedic treatment. Our experience

Clasificación de Herring

Clasificación de Stulberg

Evaluación a pacientes que fueron internados por presentar enfermedad de Legg-Calve-Perthes. Hogar Clínica San Juan de Dios de Arequipa entre 1984 a 1995

Se realizó un trabajo de investigación en el Hogar Clínica San Juan de Dios de Arequipa, sobre una población total de 18 pacientes, que presentaron la enfermedad de Legg-Calvé-Perthes y que fueron internados en dicha institución para su tratamiento especializado respectivo, entre el periodo de enero de 1984 a diciembre de 1995 (12 años). Utilizando el método descriptivo, retrospectivo; se revisaron 18 historias clínicas y radiográficas tomadas. Se obtuvo información que se anotó en fichas individuales de recolección de datos; los cuales fueron tabulados estadísticamente. Se realizó una evaluación actual clínica radiológica de la población accesible en estudio; llegando a obtener resultados que fueron analizados. Posteriormente se ha llegado a varias conclusiones, ya que el presente trabajo trata de la enfermedad en general, y no se ocupa de un sólo aspecto; asimismo se ha presentado las sugerencias respectivas.

Doença de Legg-Calvé-Perthes. III.- Estudo radiográfico de 105 quadris / Legg-Calvé-Perthes disease. III.- Radiographic study of 105 hips

Os autores realizaram estudo radiográfico de 87 pacientes (105 quadris) portadores da doença de Legg-Calvé-Perthes. Houve maior freqüência de quadris na fase de fragmentaçäo do que nas de necrose e ossificaçäo. Em relaçäo à classificaçäo de Catterall, a maior parte se enquadrou nos grupos 3 e 4. Dos quadris classificados segundo Salter & Thompsom, a grande maioria se encontrava no grupo B. A porcentagem de quadris com sinais de risco foi crescente da fase de necrose até a de recossificaçäo. Foram considerados quadris em risco radiográfico aqueles que na abduçäo de 30- e discreta rotaçäo interna permaneceram extrusos, segundo o método descrito por Dickens & Menelaus