Abstract
The purpose of this study was to evaluate the outcomes of patients with Legg–Calvé–Perthes disease (LCPD) with disease onset before 6 years of age who were treated with conservative methods and to identify prognostic factors. Moreover, we evaluated the duration of the Waldenström stage and its correlation with the disease outcome. Disease severity was assessed using the lateral pillar classification, and the final outcome was evaluated using the Stulberg classification. We divided patients with LCPD into two groups according to the age at onset: group 1 (<4 years) and group 2 (4–6 years). The final outcomes of the two groups were compared. We also assessed the duration of each Waldenström stage. LCPD was noted in 49 hips of 49 patients. The lateral pillar class was A in one patient, B in 29 patients, and B/C or C in 19 patients. The Stulberg class was I or II (good) in 30 patients, III (fair) in 13 patients, and IV or V (poor) in six patients. The lateral pillar class significantly correlated with the final outcome. Groups 1 and 2 comprised 25 and 24 patients, respectively. The prevalence of good outcomes did not significantly differ between the groups (p = 0.162). The duration of the initial stage was 4.1 months in the good outcome group and 6.2 months in the fair or poor outcome group. The duration of the fragmentation stage of the femoral head was 5.9 months in the good outcome group and 11.9 months in the fair or poor outcome group. The durations of initial and fragmentation stages significantly differed between good outcome group and fair or poor outcome group (p = 0.009 and p < 0.001, respectively). The prognosis of patients with disease onset before the age of 6 years was favorable. The disease severity and duration of each Waldenström stage can be predictors of the outcome. Patients with prolonged initial and fragmentation stages showed worse outcomes and often required more active treatment to shorten the durations of the initial and fragmentation stages.
Highlights
The prognosis of Legg–Calvé–Perthes disease (LCPD) varies with the patient’s age at disease onset
Patients diagnosed with LCPD under the age of 6 years were classified using Herring’s lateral pillar classification at the time of maximum fragmentation
The lateral pillar class significantly correlated with the final outcome (p < 0.001)
Summary
The prognosis of Legg–Calvé–Perthes disease (LCPD) varies with the patient’s age at disease onset. LCPD occurring in children under 6 years of age is usually a benign, self-limiting condition with a good outcome [1,2,3]. In children under 6 years of age, the Catterall and lateral pillar classes of LCPD correlate with the prognosis [4,5,6,7]. The Waldenström classification of LCPD is based on radiographic changes over time as the disease progresses naturally. LCPD has four radiographic stages: initial, fragmentation, reossification, and residual [8]. The time from the first radiographic evidence of disease to the start of fragmentation was a mean of 6 (range: 1–14) months, with fragmentation and reossification stages lasting
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