Legg-Calvé-Perthes Research Articles

Investigating the association between self-reported physical function, temporo-spatial parameters, walking kinematics and community-based ambulatory activity: Analysis of post-operative hip preservation patients

IntroductionWearable sensors provide the ability to assess ambulatory activity in the community after hip preservation surgery (HPS). In combination with gait analysis and patient reported outcomes, more perspective on post-operative function is gained. The purpose of this study was to assess the relationship between self-reported function/activity, temporo-spatial parameters and walking kinematics to objectively measured ambulatory activity. MethodsForty-nine participants (38 Females; age range 16–38 years) who were five years or more post-surgery and the following diagnoses were included: Acetabular Dysplasia (n=34), Femoroacetabular Impingement (n=12) and Legg-Calvé Perthes disease (n=3). Participants underwent 3D gait analysis and gait deviations were quantified using the Gait Deviation Index (GDI) and Gait Profile Score (GPS). Temporo-spatial parameters were also calculated. Self-reported pain/function and activity level were assessed via the Harris Hip Score (HHS) and UCLA Activity Scale (UCLA). Participants wore a StepWatch Activity Monitor in their community and the Intensity/Duration of ambulatory bouts were analyzed. Spearman correlation coefficients were run to assess the following relationships: in-lab walking measures, self-reported function/activity vs.community ambulatory activity. ResultsThere were no statistically significant correlations between HHS, UCLA or temporospatial parameters with ambulatory activity (p>0.05). Worsening gait deviations (GDI/GPS scores) correlated with daily total ambulatory time (ρ=0.284/-0.284, p<0.05), time spent in Short duration ambulatory bouts (ρ=-0.321/0.321, p<0.05) and the amount of time in Long duration ambulatory bouts (ρ=0.366/-0.366, p<0.05). The amount of time spent in Easy intensity/Short duration and Easy intensity/Long duration ambulatory bouts did have a weak correlation with the GDI and GPS (p<0.05). ConclusionsIn HPS patients after long-term follow up, ambulatory activity in the community did not correlate with patient reported outcomes but there was a weak correlation with the presence of gait deviations. Incorporating wearable sensors to assess community ambulatory bout intensity/duration, provides additional quantifiable measures into the overall function of patients following HPS

Detection of early metaphyseal changes in a piglet model of Legg-Calvé-Perthes disease using quantitative mapping of MRI relaxation times.

Legg-Calvé-Perthes disease (LCPD) is a childhood hip disorder characterized by ischemic injury to the epiphysis of the femoral head, but changes to the metaphysis have also been implicated in its pathogenesis. Quantitative magnetic resonance imaging (MRI) relaxation time mapping techniques are potentially useful to detect injury in LCPD, but studies to date have focused on the epiphysis. The purpose of this study was to assess whether T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation times can detect early metaphyseal changes in an LCPD piglet model. Complete epiphyseal ischemia of one femoral head was surgically induced and confirmed using contrast-enhanced MRI in n = 10 6-week-old piglets; the contralateral side was unoperated. The bilateral hips were imaged 1 week after surgery in vivo at 3T MRI using relaxation time mapping and contrast-enhanced MRI. Relaxation times and thicknesses of the metaphyseal primary and secondary spongiosa were measured and compared between the ischemic and contralateral-control femoral heads using paired t-tests. In the ischemic femoral heads, T2 relaxation times were significantly increased in the primary spongiosa (6.7 ± 9.8 ms, p = 0.029), and T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation times were significantly decreased in the secondary spongiosa (respectively: -13.3 ± 9.3 ms, p = 0.013; -32 ± 23 ms, p < 0.001; -43 ± 41 ms, p = 0.009; and -39 ± 13 ms, p < 0.001). The secondary spongiosa thickness was also significantly decreased in the ischemic femoral heads (p < 0.001). In conclusion, T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation time mapping techniques can detect early changes in the metaphysis following ischemic injury to the epiphysis of the femoral head in a piglet model of LCPD.

A case of pediatric Perthes’ disease with unexplained hyperlactatemia at the time of initial surgery and anesthetic management with remimazolam for the subsequent surgery

BackgroundThe causes of perioperative hyperlactatemia vary, but they are generally associated with hypoperfusion. Here, we report the case of a pediatric patient who developed unexplained hyperlactatemia during anesthesia with propofol and sevoflurane, which recurred during a second surgery under anesthesia with remimazolam.Case presentation.An 8-year-old boy with Perthes disease and no remarkable past or family history was scheduled for an osteotomy. Anesthesia was induced with propofol and rocuronium and then maintained with sevoflurane and remifentanil. The patient developed lactic acidosis without hemodynamic instability during anesthesia, with a normal lactate/pyruvate ratio after surgery, suggesting a lack of hypoperfusion. We used remimazolam instead of propofol during the second surgery 6 months later, considering the possibility of drug-induced lactic acidosis, including malignant hyperthermia and propofol infusion syndrome, where the unexplained hyperlactatemia recurred.ConclusionsDistinguishing the causes of hyperlactatemia, particularly in the absence of other symptoms, is challenging. The lactate/pyruvate ratio during episodes of hyperlactatemia can provide insights into the underlying pathology.

Proximal femoral varus osteotomy for Legg–Calvé–Perthes disease: Do age and lateral pillar classifications influence short-to-mid-term clinical and radiological outcomes?

IntroductionProximal femoral varus osteotomy (FVO) is one of the most used treatment methods with acceptable outcomes for Legg–Calvé–Perthes disease (LCPD). We aimed to investigate the influence of age at disease onset and the Lateral Pillar classification on clinical and radiological outcomes of FVO surgery LCPD patients between 6–12years of age. HypothesisProximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up, regardless of preoperative age and Herring type. Material and methodsFifty patients with LCPD (Herring groups B, B/C, and C) who underwent FVO were retrospectively reviewed. We evaluated radiological [center-edge angle, extrusion index, epiphyseal index, acetabular index, articulo-trochanteric distance (ATD)] and clinical [hip abduction range of motion (ROM), Trendelenburg sign, pain, and Harris hip score (HHS)] outcomes with a follow-up of 37.3±10.5months (range: 24–180months). Finally, the overall treatment outcome was assessed using the Stulberg classification. ResultsThe ROC curve analysis did not reveal any significant relationship between age and clinical or radiological outcomes, and there was no predictable age cut-off for surgical outcomes (p=0.13). No significant difference was found in Stulberg classification at the follow-up between patients with type B, B/C, and C of the lateral pillar (p>0.05). DiscussionOur results demonstrated that open-wedge proximal FVO surgery in the early fragmentation phase of LCPD patients led to acceptable clinical and radiographic outcomes in a 3-year follow-up. Each sample of our study was very small and a lot of variables were measured, making this result not adequately strong enough to draw a robust conclusion. However, FVO surgery remains a possible suggestion for patients in the early fragmentation phase, and age and lateral pillar type may not be limiting factors. Level of evidenceIV; therapeutic retrospective cohort.

A combined treatment strategy of Legg-Calve-Perthes disease with BEST quartet.

Abstract Purpose: The main pathology of Legg-Calvé-Perthes Disease (LCPD) is the disruption of blood flow of the femoral head resulting ischemic necrosis which leads hip joint incongruency. The most frequent methods in the treatment are the methods improving the containment of the femoral head. Our study aimed to investigate the mid-long-term outcomes of LCPD patients treated with the BEST method, which aims to improve congruency and containment simultaneously. Materials and methods: LCPD patients who were treated with (B)leeding the epiphysis by drilling, (E)vacuation of the joint synovitis, contained with (S)alter’s Osteotomy, and distracted with skin (T)raction investigated retrospectively. Only patients who reached skeletal maturity were included in the study. Patients’ final radiographs were classified according to the Stulberg classification, Mose classification, and Tönnis osteoarthritis classification. Results: The mean follow-up of the patients was 10.44±1.35 (8.5-13) years, and the mean age at the last follow-up was 17.71±1.73 (15.25-20.83) years. According to the Stulberg classification, 11 (45.8%) of the patients had a Class-I hip; 6 (25%) a Class-II hips; 3 (12.5%) a class-III hips, 4 (16.7%) a class-IV hips. According to the Mose classification, 12 (50%) of the patients had good results; 5 (20.8%) had fair results; 7 (29.1%) had poor results. Conclusion: In conclusion BEST treatment method for LCPD is a combined procedure which addresses to all pathologies of disease at the same time. This combined treatment protocol may be preferred for severely affected LCPD cases who with subluxation especially in higher lateral pillar class that are prone to nonspherical incongruency.

Predictors of Persistent Limp Following Proximal Femoral Varus Osteotomy for Perthes Disease.

One of the most popular containment procedures for Legg-Calvé-Perthes disease (LCPD) is proximal femur varus osteotomy (PFO). While generally successful in achieving containment, PFO can cause limb length discrepancy, abductor weakness, and (of most concern for families) a persistent limp. While many studies have focused on radiographic outcomes following containment surgery, none have analyzed predictors of this persistent limp. The aim of this study was to determine clinical, radiographic, and surgical risk factors for persistent limp 2 years after PFO in children with LCPD. A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 years at disease onset with unilateral early-stage LCPD (Waldenström I) who underwent PFO. Limp status (no, mild, and severe), age, BMI, and pain scores were obtained at initial presentation, 3-month, and 2-year postoperative visits. Preoperative and follow-up radiographs were used to measure traditional morphologic hip metrics including acetabular index (AI), lateral center-edge angle (LCEA), and femoral neck-shaft angle (NSA). Univariate analysis as well as multivariate logistic regression models were used to analyze factors associated with mild and severe limp at the 2-year visit. A total of 95 patients met the inclusion criteria, and of these 50 patients underwent concomitant greater trochanter apophysiodesis (GTA) at the time of PFO. At the 2-year visit, there were 38 patients (40%) with a mild or severe limp. Multivariate logistic regression revealed no significant radiographic factors associated with a persistent limp. However, lower 2-year BMI and undergoing GTA were associated with decreased rates of persistent limp regardless of age ( P <0.05). When stratifying by age of disease onset, apophysiodesis appeared to be protective against any severity of limp in patients aged 6 to 8 years old ( P = 0.03), but not in patients 8 years or older ( P = 0.49). Persistent limp following PFO is a frustrating problem that was seen in 40% of patients at 2 years. However, lower follow-up BMI and performing a greater trochanter apophysiodesis, particularly in patients younger than 8 years of age, correlated with a lower risk of postoperative limp.

Gait Compensation among Children with Non-Operative Legg-Calvé-Perthes Disease: A Systematic Review.

A systematic electronic search was performed using MEDLINE, CINAHL, Embase, BIOSIS, and the Cochrane Library to identify studies published from inception up until December 2023. An adapted Downs and Black checklist was utilised to assess methodological quality and project risk of bias. Percentage agreement and nominal kappa statistics with bootstrapped bias-corrected 95% confidence intervals (CIs) were used. A comprehensive literature search revealed 277 citations for review, of which 210 studies entered full-text screening. In total, eight studies met the inclusion criteria for quality assessment by two independent reviewers. The results revealed variations in data quality, with scores ranging from 12 to 17 due to missing information related to subject characteristics, biomechanical model, and power calculation. This review reveals common compensation strategies associated with walking among non-operative children with Perthes disease such as Trendelenburg gait due to weakness of the hip abductor muscle.

Pathogenic Gene Variants Identified in Patients Presenting With Perthes or Perthes-like Hip Disorder.

Legg-Calve-Perthes disease (LCPD) is a diagnosis of exclusion. Various conditions, such as skeletal dysplasias, can closely mimic LCPD and these must be ruled out to provide appropriate treatment, prognosis, and counseling. Traditionally, genetic testing has not been readily available in pediatric orthopaedic practice. Furthermore, the clinical value of genetic testing patients with LCPD is unclear. With the advance of next-generation sequencing (NGS) technology, genetic testing has become clinically available as a lab test. The purposes of this study were to assess the clinical utility of genetic testing in select patients with LCPD and to determine the patient characteristics of those who tested positive for skeletal dysplasia. This is an IRB-approved, retrospective study of 63 consecutive patients who presented with Perthes-like symptoms and/or x-ray findings and who had genetic testing. The reason(s) for genetic testing included bilateral hip disease, family history of LCPD, short stature, suspected skeletal dysplasia, atypical radiographic findings, and/or combinations of these reasons. Of the 63 patients, 19 patients (30%) were found to have a pathogenic gene variant. In 8 of the 19, a variety of skeletal dysplasia was diagnosed. The remaining 11 patients were found to be carriers of autosomal recessive disorders. All 19 patients were referred for genetic counseling. Of the 8 patients found to have skeletal dysplasia, 3 had bilateral disease, 3 were <10 percentile in height, 1 had a family history of "LCPD," and 3 had atypical x-ray findings. In addition to the pathogenic variants, numerous genetic variants of unknown significance were found with 2 gene variants showing exactly the same variant found in 2 unrelated patients. With 30% of the patients showing pathogenic results, genetic testing of select patients with Perthes-like disease is valuable in detecting an underlying genetic disorder or a carrier status of a genetic disorder.

Bone Remodeling and Bone Structural Genes in Legg-Calvé-Perthes Disease: The OPG rs2073618 and IL-6 rs1800795 Are Associated with High Risk in Mexican Patients.

Legg-Calve-Perthes disease (LCPD) is an idiopathic avascular necrosis of the pediatric femoral head. Bone remodeling and bone structural genes have the potential to contribute to the progression of LCPD when there is disequilibrium between bone resorption and bone formation. A case-control study was performed to search for associations of several common polymorphisms in the genes Receptor Activator for Nuclear Factor κappa B (RANK), Receptor Activator for Nuclear Factor κappa B Ligand (RANKL), osteoprotegerin (OPG), interleukin (IL)-6, and type 1 collagen (COL1A1) with LCPD susceptibility in Mexican children. A total of 23 children with LCPD and 46 healthy controls were genotyped for seven polymorphisms (rs3018362, rs12585014, rs2073618, rs1800795, rs1800796, rs1800012, and rs2586498) in the RANK, RANKL, OPG, IL-6, and COL1A1 genes by real-time polymerase chain reaction with TaqMan probes. The variant allele (C) of IL-6 rs1800795 was associated with increased risk of LCPD (odds ratio [OR]: 3.8, 95% confidence interval [CI]: [1.08-13.54], p = 0.033), adjusting data by body mass index (BMI) and coagulation factor V (FV), the association with increased risk remained (OR: 4.9, 95% CI: [1.14-21.04], p = 0.025). The OPG polymorphism rs2073618, specifically GC-GG carriers, was associated with a more than fourfold increased risk of developing LCPD (OR: 4.34, 95% CI: [1.04-18.12], p = 0.033) when data were adjusted by BMI-FV. There was no significant association between RANK rs3018362, RANKL rs12585014, IL-6 rs1800796, COL1A1 rs1800012, and rs2586498 polymorphisms and LCPD in a sample of Mexican children. The rs1800975 and rs2037618 polymorphisms in the IL-6 and OPG genes, respectively, are informative markers of increased risk of LCPD in Mexican children.

Comparison of Conservative and Surgical Treatment in Patients with Legg-Calve-Perthes Disease

Objectives: The overall main purpose of this study is to add some knowledge on the treatment of LCPD, with a main focus on the comparison between conservative and surgical treatments of Legg-Calve-Perthes Disease (LCPD). And a brief overview of the complications of these treatments. Methods: A retrospective cohort method was used in this study. A total number of 53 patients were registered with LCPD, at the first affiliated hospital of Xinjiang Medical University. Out of these 53 patients, 39 patients were included in this study, rest of 14 patients couldn’t be included due to missed data or loss of contact. For the comparison of results, a modified form of the Harris Hip Score (HHS) was used for the clinical assessment of hip function. Radiographs were also used for the evaluation. The radiological assessment was made by the use of CE and CCD angles. The main classification system, which was used for the evaluation, staging, and prognosis of hip function, was Stulberg’s classification. Statistical analysis was done by using the SPSS 23.0 version. A simple t-test was used for data analysis. Results: The clinical results supported our hypothesis that surgical treatment is a better choice of treatment than conservative treatment in patients with LCPD. However, the statistical data from radiographic assessment showed no significant difference between conservative and surgical treatment in patients with LCPD. The statistical data showed that both conservative and surgical treatment had significant p-values (&lt;0.05) when compared results at the final follow-up check with that before starting treatment. So conservative treatment can be used as an alternative to surgical treatment in patients with Legg-Calve-Perthes Disease. Conclusion: From the statistical analysis of data, we concluded that there is no significant difference between outcomes of conservative and surgical treatment in patients with Legg-Calve-Perthes Disease (LCPD). So conservative treatment can be ........

The Effect of Vitamin D Deficiency as a Risk Factor of Early Fragmentation in Legg-Calve-Perthes Disease: A Prospective Study.

Legg-Calve-Perthes disease (LCPD) is a disorder involving the hips in young children of preschool and school-going age groups, more common in 4-8 years. The insufficient blood supply to the femoral head is the main reason behind various etiologic theories. Multiple factors affect the natural progression of the disease. The natural progression of the disease involves early avascular necrosis, fragmentation, reconstitution, and healed stages. In the fragmentation stage, the bony epiphysis begins to fragment, and the subchondral radiolucent zone (crescent sign) is the result of a subchondral stress fracture, which later on determines the extent of a necrotic fragment of the femoral head. These changes later contribute to changes in the shape of the femur head and the extent of deformity. As vitamin D plays a vital role in the onset of the fragmentation stage, we conducted a study to assess the effect of vitamin Ddeficiency as a risk factor for early fragmentation in Legg-Calve-Perthes disease. In our study, 50 patients aged 4-12 years were examined over three years and classified according to Catterall and Herring's lateral pillar classification; the length of the fragmentation stage and the vitamin D levelwere considered. A vitamin D level of less than 20 ng/mL was labeled as the deficient group, 20-30ng/mL as the insufficient group, and more than 30 ng/mL as the sufficient (normal) group. The critical fragmentation stage was significantly longer (more than 12 months) in vitamin D deficiency (34%), leading to a higher risk of deformity and extrusion of the femoral head, which led to higher rates of surgical intervention and containment procedures. The fragmentation stage is critical in the course of LCPD. Vitamin D levels play a vital role in predicting the prognostic of LCPD, and it should bemeasured in all patients of LCPD. Patients with normal vitamin D levels have a comparatively shorter fragmentation stage duration than patients with insufficient or deficient levels, leading to a lesser duration of femoral head damage.

Two-Stage Total Hip Arthroplasty Management in Advanced Legg-Calvé-Perthes Disease: A Case Report

Introduction: Legg-Calvé-Perthes-Disease (LCPD) most commonly affects boys between the ages of 4 and 8. It is an avascular necrosis of the upper femoral epiphysis. Its etiopathogenesis is unknown. Advanced cases necessitate innovative approaches beyond conservative measures. We report a challenging case involving radical treatment for advanced LCPD already complicated by hip and knee stiffness, managed with a two-stage total hip arthroplasty. Case presentation: We report the case of a 14-year-old with chronic left hip impairment and concurrent knee stiffness due to advanced LCPD. Initial conservative interventions proved ineffective. We decided to opt for a two-stage surgical strategy. The first stage involved femoral head ostectomy, cervico-cephalic prosthesis placement, and soft tissue tenotomy. Subsequent intensive rehabilitation achieved improved joint mobility. The second stage comprised total hip replacement using a ceramic-ceramic prosthesis. At last follow up, a favorable functional outcome was observed, and radiographs demonstrated a well-positioned and osteo-integrated prosthesis. Conclusions: LCPD is a serious condition, and the prognosis is significantly influenced by early diagnosis and appropriate management. In cases of advanced staged LCPD, prosthetic replacement becomes a suitable option, even in younger patients. Despite potential complications, the use of a two-stage approach, integrating surgical intervention and tailored rehabilitation, proved effective in restoring joint function. This case highlights the importance of personalized planning and a staged approach in addressing the multifaceted aspects of LCPD.

Severe osteolysis in a patient with Legg-Calvé-Perthes disease 32 years after primary total hip replacement: A case report

This article presents a case report of a 73-year-old woman with Legg-Calvé-Perthes disease (LCPD) which developed late-onset osteolysis after a primary total hip replacement (THR). LCPD is a complex childhood hip disorder that can cause bone necrosis, deformation, and premature osteoarthritis with an increased risk of osteolysis after primary THR and therefore a higher risk of revision surgery. The acetabular component was unstable, with pronounced polyethene wear, and mechanical deformation and loosening of the acetabular component. The case was managed with the revision of THR using a non-cemented acetabular and femoral component, polyethene insert and ceramic head, which resulted in a smooth postoperative period. The article also discusses the incidence of LCPD and its association with osteolysis, highlighting the importance of considering medical history to manage complications after primary THR.

Global trends in the research on Legg-Calve-Perthes disease in Web of Science.

Legg-Calve-Perthes disease (LCPD) is a form of idiopathic femoral head necrosis that can lead to permanent femoral head deformities and premature osteoarthritis in children under the age of 15. Its pathogenesis is utterly and remains to be clarified. Although many research publications on LCPD have emerged during the last few decades, few systematic bibliometric analyses of these articles have been reported. A bibliometric analysis was performed to investigate the development processes and hotspots, as well as the collaboration and influence among countries, institutions, authors, journals, and keywords of papers relevant to LCPD from the Web of Science Core Collection (WoSCC) during the period from 1 January 2000 to 30 June 2023. A total of 2,205 researchers from 916 institutions across 53 countries/regions have contributed to 673 papers published in 199 academic journals. The research on LCPD has shown significant fluctuations but a gradual increase in the number of articles published over the last two decades. The United States leads in the number of publications of LCPD, with the Texas Scottish Rite Hospital for Children being the most productive institution. English, as the most widely used language in the world, was undoubtedly the most popular language. Herring JA, who acted as both the corresponding and first author, has contributed to the most co-cited papers published. The most number of LCPD papers are published in the Journal of Pediatric Orthopaedics, whereas the Journal of Bone and Joint Surgery American Volume garnered the highest total citations, indicating the great importance of these two journals in the field of orthopedics. The most frequently used keywords in published articles were related to the symptoms, mechanisms, and prognosis, revealing the research focus of most scholars. Our research described the development trends and hotspots in the research field of LCPD and will help researchers make better decisions.

Biochanin A inhibits endothelial dysfunction induced by IL‑6‑stimulated endothelial microparticles in Perthes disease via the NFκB pathway.

Endothelial dysfunction caused by the stimulation of endothelial microparticles (EMPs) by the inflammatory factor IL-6 is one of the pathogenic pathways associated with Perthes disease. The natural active product biochanin A (BCA) has an anti-inflammatory effect; however, whether it can alleviate endothelial dysfunction in Perthes disease is not known. The present in vitro experiments on human umbilical vein endothelial cells showed that 0-100 pg/ml IL-6-EMPs could induce endothelial dysfunction in a concentration-dependent manner, and the results of the Cell Counting Kit 8 assay revealed that, at concentrations of <20 µM, BCA had no cytotoxic effect. Reverse transcription-quantitative PCR demonstrated that BCA reduced the expression levels of the endothelial dysfunction indexes E-selectin and intercellular cell adhesion molecule-1 (ICAM-1) in a concentration-dependent manner. Immunofluorescence and western blotting illustrated that BCA increased the expression levels of zonula occludens-1 and decreased those of ICAM-1. Mechanistic studies showed that BCA inhibited activation of the NFκB pathway. In vivo experiments demonstrated that IL-6 was significantly increased in the rat model of ischemic necrosis of the femoral head, whereas BCA inhibited IL-6 production. Therefore, in Perthes disease, BCA may inhibit the NFκB pathway to suppress IL-6-EMP-induced endothelial dysfunction, and could thus be regarded as a potential treatment for Perthes disease.

Clinical case report of a 7-year-old patient with Perthes disease

Clinical case report of a 7-year-old patient with Perthes disease

Radiographic outcome after greater trochanteric epiphysiodesis in patients with Perthes disease.

Legg-Calvé-Perthes disease often leads to greater trochanteric overgrowth, which negatively affects the biomechanics of the hip joint. This study aimed to evaluate the physiologic growth of the greater trochanter and the effectiveness of greater trochanteric epiphysiodesis radiographically. Retrospectively, 46 children (33 male, average age at greater trochanteric epiphysiodesis 8 ± 1.3 years) with unilateral Legg-Calvé-Perthes disease undergoing greater trochanteric epiphysiodesis with screws and curettage of the epiphysis were included. On radiographs of the pelvis pre- and postoperatively (mean follow-up 3.5 years), trochanteric height, articulotrochanteric distance, and center-trochanter distance were determined and compared to the unaffected side. Reference values for the physiological development of trochanteric height, articulotrochanteric distance, and center-trochanter distance over time were established. Greater trochanteric epiphysiodesis reduced trochanteric growth by 29% measured by trochanteric height, but only statistically significant in the group "<8 years" (p = 0.02). Regression analysis revealed inhibition of trochanteric growth of 0.92 mm/year. Both articulotrochanteric distance and center-trochanter distance of the affected and unaffected side converged during the follow-up period: articulotrochanteric distance of the affected hip increased (preop: 11.2 ± 7 mm, maturity: 18.5 ± 10 mm; p < 0.01) compared to no change on the unaffected side (preop: 19.3 ± 5 mm, maturity: 18 ± 6 mm; p = 0.69). Center-trochanter distance of the affected hip stayed unchanged (preop: (-7.9) ± 7 mm, maturity: (-7.8) ± 9 mm; p = 0.13). On the unaffected side, center-trochanter distance became negative (preop: 0.9 ± 6 mm, maturity: (-6.5) ± 5 mm; p < 0.001). Measured by articulotrochanteric distance and center-trochanter distance, 31.8% achieved an optimal result. Greater trochanteric epiphysiodesis has a positive effect on greater trochanter growth and therefore on hip anatomy. Further studies must show whether these positive effects also result in biomechanical and functional benefits. level III.

Atraumatic Limping Child, a Challenge for Pediatricians: An Observational Age-Related Study in a Pediatric Emergency Department.

Atraumatic limping is a frequent cause of consultation in Pediatric Emergency Departments (PED) and often represents a challenge for pediatricians for its variability in etiology ranging from benign causes to potential crippling conditions. The aims of this research are to illustrate the clinical features of acute limping children (LC) and to identify the possible red flags that could help to make a diagnosis of severe pathologies. We carried out a retrospective study about non-traumatic limping children referred to the PED of Bambino Gesù Children's Hospital over a 2-year period. We divided the cohort into three groups based on the patient's age: toddlers, children and adolescents. We considered crippling conditions: oncologic etiologies, bone or neurological infections, epiphysiolysis, Perthes disease, Guillain Barrè syndrome and non-accidental injuries. We analyzed 485 patients. At clinical evaluation, 19.5% of the patients presented at least one sign and/or symptom of red flags. Crippling conditions (6.2% of the total population) showed red flags in 36.7%. Transient synovitis of the hip was the most frequent diagnosis. We found crippling conditions in 30 patients, mostly represented by toddlers. Our data suggest that toddlers and patients presenting red flags should be evaluated with particular suspicion because they have an increased risk of underlying severe conditions.

Positive outcome reporting in orthopaedic literature.

Perthes' disease (PD) is a relatively rare syndrome of idiopathic osteonecrosis of the proximal femoral epiphysis. Treatment for Perthes' disease is controversial due to the many options available, with no clear superiority of one treatment over another. Despite having few evidence-based approaches, many patients with Perthes' disease are managed surgically. Positive outcome reporting, defined as reporting a study variable producing statistically significant positive (beneficial) results, is a phenomenon that can be considered a proxy for the strength of science. This study aims to conduct a systematic literature review with the hypothesis that positive outcome reporting is frequent in studies on the treatment of Perthes' disease. We conducted a systematic review of all available abstracts associated with manuscripts in English or with English translation between January 2000 and December 2021, dealing with the treatment of Perthes' disease. Data collection included various study characteristics, surgical versus non-surgical management, treatment modality, mean follow-up time, analysis methods, and clinical recommendations. Our study included 130 manuscripts. Overall, 110 (85%) reported positive (beneficial) results, three (2%) reported negative results, and 17 (13%) reported no significant difference. Despite only 10/130 studies (8%) having a testable hypothesis, 71 (55%) recommended the use of their studied treatment methods for the patients, five (4%) made recommendations against the use of the studied treatment modality, and 54 (42%) did not make any recommendations. The overall rate for positive outcomes among included manuscripts regarding different treatment methods for Perthes' disease (85%) is higher than the 74% positive outcome rate found among studies for other surgically treated disorders and significantly higher than most scientific literature. Despite the lack of testable hypotheses, most manuscripts recommended their studied treatment method as a successful option for managing patients solely based on the reporting of retrospective data.

Legg-Calvé-Perthes Disease: Diagnosis, Decision Making, and Outcome.

Legg-Calvé-Perthes disease (LCPD), or idiopathic avascular necrosis of the proximal capital femoral epiphysis in children, has a variable presentation and can result in significant femoral head deformity that can lead to long-term functional deficits. Plain radiographic imaging is crucial in diagnosing LCPD and guiding treatment. Although the etiology of LCPD remains unknown, the evolution of the disease has been well characterized to include the phases of ischemia, revascularization, and reossification. The mechanical weakening during these phases of healing place the femoral head at high risk of deformity. Treatment of LCPD, therefore, focuses on minimizing deformity through operative and nonoperative strategies to reduce the risk of premature osteoarthritis. Advanced imaging using perfusion MRI may refine surgical decision making in the future, and biological treatments to improve femoral head healing are on the horizon.