Legg-Calvé-Perthes Research Articles

Clinical and radiological outcomes following surgical hip dislocation for paediatric hip pathologies, a prospective cohort study

BackgroundSurgical Hip Dislocation (SHD) is a powerful tool in the armamentarium of any surgeon treating conditions affecting the hips of children presenting with sequelae of a number of common conditions including Legg-CalvéPerthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). Risks associated with the procedure are well described. We investigated to assess if SHD is associated with significant surgical risk and if it improved clinical outcomes for patients. MethodsWe conducted a prospective cohort study. We reviewed 18 (11 males and 7 females; mean age 13.7 years (6–17) with symptomatic hip pathology, secondary to femoroacetabular impingement (FAI) between 2017 and 2021. All patients underwent a surgical hip dislocation approach and femoral head-neck osteochondroplasty, Head Split osteotomy or both. Clinical improvement was assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. The minimum follow-up was 6 months (mean, 22 months; range, 6–42 months). ResultsWOMAC scores improved at final follow-up from 10 to 3 for pain, 33 to 10 for function, and 4 to 2 for the stiffness subscales. All radiographic measures improved significantly of the postoperative X-rays. No patients developed osteonecrosis, implant failure, deep infection, or nonunion. ConclusionSurgical Hip Dislocation, in the short term, we found improvement in WOMAC scores and radiographic indices with a low complication rate.

Development of acetabular retroversion in LCPD hips—an observational radiographic study from early stage to healing

BackgroundAcetabular retroversion is observed frequently in healed Legg–Calvé–Perthes disease (LCPD). Currently, it is unknown at which stage and with what prevalence retroversion occurs because in non-ossified hips, retroversion cannot be measured with standard radiographic parameters.MethodsIn a retrospective, observational study; we examined pelvic radiographs in children with LCPD the time point of occurrence of acetabular retroversion and calculated predictive factors for retroversion. Between 2004 and 2017, we included 55 children with a mean age of 5.7 ± 2.4 years at diagnosis. The mean radiographic follow-up was 7.0 ± 4.4 years. We used two new radiographic parameters which allow assessment of acetabular version in non-ossified hips: the pelvic width index and the ilioischial angle. They are based on the fact that the pelvic morphology differs depending on the acetabular version. These parameters were compared among the four Waldenström stages and to the contralateral side. Logistic regression analysis was performed to determine predictive factors for acetabular retroversion.ResultsBoth parameters differed significantly among the stages of Waldenström (p < 0.003 und 0.038, respectively). A more retroverted acetabulum was found in stage II and III (prevalence ranging from 54 to 56%) compared to stage I and IV (prevalence ranging from 23 to 39%). In hips of the contralateral side without LCPD, the prevalence of acetabular retroversion was 0% in all stages for both parameters. Predictive factors for retroversion were younger age at stage II and IV, collapse of the lateral pillar in stage II or a non-dysplastic hip.ConclusionsThis is the first study evaluating acetabular version in children with LCPD from early stage to healing. In the developing hip, LCPD may result in acetabular retroversion and is most prevalent in the fragmentation (stage II) and early healing stage (stage III). Partial correction of acetabular retroversion can occur after healing. This has a potential clinical impact on the timing and type of surgical correction, especially in pelvic osteotomies for correction of acetabular version.Level of evidenceLevel III, retrospective observational study.

Simultaneous femoral head reduction osteotomy (FHRO) combined with periacetabular osteotomy (PAO) for the treatment of severe femoral head asphericity in Perthes disease

BackgroundThe purpose of this study is to describe the midterm clinical and radiologic outcomes of concurrent femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO) in Legg–Calvé–Perthes disease (LCPD) patients with major aspherical femoral head deformities.MethodsThe study included four Perthes patients in Stage IV of Waldenstrom’s classification with a mean age of 10.5 and severe femoral head asphericity. They were treated with a combination of FHRO + PAO and followed for at least 2 years. An evaluation of the radiological outcome of the surgery was carried out based on the lateral center to edge angle (LCEA), the anterior center to edge angle (ACEA), the Tönnis angle, the head sphericity index, the Stulberg classification, the extrusion index, and Shenton’s line integrity. An evaluation of the clinical outcome was made by evaluating hip range of motion (ROM), Harris hip score (HHS), and Merle d’Aubigne´-Postel score.ResultsAll radiographic measures improved; three patients were classified as Stulberg class II and one as class III. The LCEA, ACEA, and Tönnis angle improved by 29° (from 3° to 32°), 16° (from 14° to 30°), and − 10° (from 18° to 8°), respectively. The mean femoral head sphericity index and extrusion index improved by 12% (from 83 to 95%) and − 33% (from 40 to 7%). No disruption was observed in the postoperative Shenton’s line. According to HHS, all patients have shown excellent hip function, which improved by 27 points (from 69 to 96). Moreover, the hip ROM was increased from 222° to 267°. The follow-up period did not reveal any serious postoperative complications, such as osteonecrosis or conversion to arthroplasty.ConclusionsCombined FHRO with PAO may improve the hip joint’s morphology and function in patients with residual femoral head deformity and acetabular dysplasia due to LCPD. Despite being considered a complex and demanding hip surgery, these results suggest a more widespread implication of the salvage procedure.

Modeling of femoral head aseptic necrosis in Wistar rats

Aim. To develop an animal model of femoral head aseptic necrosis for studying Legg–Calvé–Perthes disease.Materials and Methods. To induce the development of aseptic necrosis, we used Wistar rats (n = 8) which suffered from combined hypoperfusion of the femoral head and increased intra-articular pressure in the hip joint. Having employed isoflurane anesthesia, we performed an incision (≈ 3 cm length) on the outer surface of the thigh in the projection of the hip joint and then excised periosteum in the proximal third of the femur. A dense vicryl ligature was applied around the femoral neck to reduce blood perfusion of the femoral head. Further, 1.5 mL 2% rheopolyglucinum solution (10% isotonic dextran, 30-40 kDa molecular weight) was injected into the hip joint cavity to increase intra-articular pressure. Rats were sacrificed upon 8-week follow-up with subsequent X-ray and histological examination.Results. Our animal model of femoral head aseptic necrosis includes two main components of Legg–Calvé–Perthes disease: an increase in the intra-articular pressure and insufficient blood perfusion of the femoral head. In all (8/8) cases, aseptic necrosis of the femoral head was achieved. Eight weeks post intervention, the condition of the proximal femur 8 was similar to impression fracture.Conclusion. Our model of femoral head aseptic necrosis fully reflects the pathogenesis of LeggCalve-Perthes disease and can be therefore used in experimental studies.

Predictors of radiographic outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease.

Treatment outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease (LCPD) have been shown to be conditioned by a number of factors that may vary across different populations. This retrospective study aimed to evaluate factors affecting radiographically assessed treatment outcomes in patients treated surgically or conservatively for LCPD at Faculty Hospital Motol, Prague, Czech Republic, between the years 2006 and 2019. Data of forty-seven children comprising 52 hips were analysed. Treatment outcomes were evaluated according to Stulberg classification. Predictors included the initial stage of fragmentation of the hip joint according to Herring classification, type of treatment (conservative or surgical), age at the time of diagnosis and sex. Older age and severity of LCPD according to Herring classification but not the type of treatment were the strongest factors determining treatment outcomes. Treatment outcomes were comparable in patients treated conservatively or surgically both across the whole cohort of patients and a group of young children < six years of age. Results strengthen the roles of severity of the LCPD at onset of treatment and age of the patient in predicting treatment outcomes in patients with LCPD. Conservative and surgical treatments appear to yield similar treatment outcomes irrespective of age of patients.

Mucopolysaccharidosis IVB and sensorineural deafness associated with the CDH23 gene: A unique clinical case

BACKROUND: Mucopolysaccharidoses are a group of lysosomal storage diseases belonging to orphan diseases. Certain types of mucopolysaccharides have a typical musculoskeletal findings and radiological changes. The mucopolysaccharidosis IVB is a rare type. Thus, 95% of cases of the mucopolysaccharidosis IV are subtype A.&#x0D; CLINICAL CASE: Сlinical and radiological changes and genetic examination were performed to a 9-year-old patient with sensorineural deafness who applied to a medical institution with complaints of right hip pain and limping.&#x0D; DISCUSSION: Based on complaints and radiological changes of the hip joints, the patient was initially diagnosed with LeggCalvePerthes disease. The presence of a symmetrical bilateral process, pathognomonic changes in the acetabulum and femoral heads, and an atypical clinic of LeggCalvePerthes disease made us suspect mucopolysaccharidos. Enzymatic analysis revealed a significant decrease in the beta-D-galactosidase enzyme activity. In addition, two compound heterozygous variants in the GLB1 gene were identified: the pathogenic variant c.808TG, inherited from the father, and an insertion of a mobile genetic element, inherited from the mother. Only one variant in the GLB1 gene was detected in the brother (born in 2009), and none of the above GLB1 variants was detected in the older brother (born in 2003). Moreover, the proband (with clinical mucopolysaccharidos IVB) and his brother (born in 2009) (without mucopolysaccharidos IVB) inherited pathogenic CDH23 variants (c.6992TC and c.805CT) from their mother and father, respectively, which is consistent with their having sensorineural hearing loss.&#x0D; CONCLUSIONS: The uniqueness of this clinical case is the presence of the rare type of mucopolysaccharidos and the separate genetic cause of sensorineural hearing loss in a single patient. The diagnosis of mucopolysaccharidos IVB in the proband was confirmed by biochemical and molecular genetic tests, and the diagnosis of CDH23-associated sensorineural deafness in the proband and brother (born in 2009) was confirmed by molecular genetic testing.

Molecular foundations of the etiology and pathogenesis of Legg-Calve-Perthes disease and prospects for targeted therapy: A literature review

BACKGROUND: The etiology and pathogenesis of the development of LeggCalvePerthes disease, despite intensive research, remains not fully understood. Most studies have concluded about the multifactorial genesis of the development of hip osteochondropathy. Moreover, a complete understanding of all elements of pathogenesis leading to the manifestation and the progressive development of aseptic necrosis make it possible to develop targeted antiresorptive therapy. At present, several studies have investigated impaired functioning of signaling pathways that influence bone homeostasis during the development of LeggCalvePerthes disease. In addition, impaired metabolism in avascular necrosis is characterized by significant complexity and heterogeneity, which is based on aseptic inflammation associated with ischemic stress. Concepts of antiresorptive therapy were developed based on the results of studies on the pathogenesis of LeggCalvePerthes disease. Nevertheless, these treatment algorithms have not achieved wide practical application and require further investigation.&#x0D; AIM: This study aimed to conduct a literary analysis of the molecular basis of the etiology and pathogenesis of LeggCalvePerthes disease and assess the prospects of therapy aimed at correcting bone homeostasis disorders.&#x0D; MATERIALS AND METHODS: Data sources were PubMed, Medline, Scopus, Web of Science, and RSCI databases, without language restrictions.&#x0D; RESULTS: The relationship between ischemic stress and the induction of a cytokine cascade with a predominance of the biological actions of proinflammatory cytokines, with parallel activation of intracellular regulatory networks that determine osteoresorptive processes, including due to pyroptosis, is shown. Data on the possibility of various variants of targeted antiresorptive therapy with the use of genetically engineered drugs are presented.&#x0D; CONCLUSIONS: The pathogenesis of LeggCalvePerthes disease is characterized by significant genetic heterogeneity with the induction of various mediators of inflammation, angiogenesis, and osteogenesis, depending on the disease stage. Investigating features of impaired bone homeostasis regulation in the case of LeggCalvePerthes disease at the molecular and cellular level opens up opportunities for the development and clinical application of personalized therapy.

Do Weightbearing Restrictions Cause Excess Weight Gain in Children With LEGG-Calvé-Perthes Disease?

Restricted weight bearing is commonly prescribed in Legg-Calvé-Perthes Disease (LCPD), raising concerns of causing overweight or obesity. This study utilizes prospectively collected data to address the following questions: (1) does body mass index (BMI) Z-score increase over the course of LCPD follow-up; (2) is having a BMI category of normal, overweight, or obese at baseline associated with BMI Z-score changes over the course of follow-up; and (3) is the duration of weight bearing restrictions (no restrictions, <3, 3 to <6, 6 to 9, or >9mo) associated with BMI Z-score changes. Data of 130 children aged 5 to 12 years with unilateral early-stage LCPD were extracted from an international database. Nation-specific BMI Z-scores and percentile-based weight categories were determined, and the duration of follow-up and weight bearing restrictions were calculated. Longitudinal changes in BMI Z-scores were evaluated for the 3 study questions using mixed effects linear regression models with surgery as a covariate. Sensitivity analyses were used to determine the influence of socio-cultural background (USA vs. India) for each study question. During the 35.5±15.9 months of follow-up, no statistically significant increase in BMI Z-scores was observed across the entire cohort, or following stratification by baseline weight categories or the duration of the weight bearing restriction. Sensitivity analyses indicated that patients in the USA had no change in their BMI Z-score. When stratified by weight categories, the normal weight of US children had a small increase in their BMI Z-score (0.005 per mo, 95% confidence interval: 0.0002, 0.009), but this was not seen in other BMI categories. The cohort of Indian children had a small but significant decrease in their BMI Z-score (-0.005/mo, 95% CI: -0.009, -0.0002). After stratification by weight categories, a small decrease of the BMI Z-score was observed only in the Indian overweight children (-0.016 per mo, 95% CI: -0.027, -0.005) and no other BMI category. Weightbearing restrictions over the course of follow-up for our cohort of children with early-stage LCPD were not associated with clinically meaningful increases of BMI Z-scores. Weight gain is multi-factorial and probably not caused by weight bearing restrictions alone. III Diagnostic Study.

Microarray analysis of lncRNA and mRNA expression profiles in patients with Legg-Calve-Perthes disease.

BackgroundThe etiology and underlying pathogenic mechanisms of Legg-Calve-Perthes disease (LCPD) still remain unclear. A disruption of blood supply to the femoral head, producing ischemic necrosis, appears to be the critical pathological event. The lncRNAs play crucial roles in many biological processes and are dysregulated in various human diseases. However, its expression profiles and the potential regulatory roles in the development of LCPD have not been investigated.MethodsIn this study, differentially expressed lncRNA and mRNA of Legg-Calve-Perthes disease patients were profiled. Several GO terms and pathways that play important roles in the regulation of vascular structure, function or coagulation were selected for further analysis. The lncRNA -mRNA interacting networks in LCPD tissues were constructed to identify novel potential targets for further investigation.ResultsThe microarray analysis revealed that 149 lncRNAs and 37 mRNAs were up-regulated, and 64 lncRNAs and 250 mRNAs were down-regulated in LCPD tissues. After filtering, we finally found 14 mRNAs and constructed an mRNA-lncRNA interacting network. Through the analysis of the interaction network, we finally found 13 differentially expressed lncRNAs, which may be implicated in the pathogenesis of LCPD. These mRNAs/lncRNAs were further validated with qRT-PCR.ConclusionThe findings of this study established a co-expression network of disease-related lncRNAs and mRNAs which screened out from the concerned G.O. terms and Pathways, which may provide new sights for future studies on molecular mechanisms of LCPD.

How do global gait indices change in localized pathology – a study in Perthes disease

How do global gait indices change in localized pathology – a study in Perthes disease

Computer-assisted design model to evaluate the outcome of combined osteotomies in Legg-Calvé-Perthes disease

ObjectiveThe current study aims to conduct a quantitative dynamic analysis of hip morphology using a computer-assisted design (CAD) model to evaluate the combined pelvic and femoral osteotomies in the treatment of Legg-Calvé-Perthes disease (LCPD).Materials and methodsCAD models of patients with unilateral LCPD treated by combined pelvic and proximal femoral osteotomies were established based on the data of CT scan, on which morphological parameters were measured. Shape difference analysis of normal hips was adopted to locate the most apparent displacement and the main strain on the surface of the proximal femur.ResultsFifteen patients were included, and the mean age of receiving operation was 6.63 years old. There were 10 hips rated as Herring type C, and the rest were type B. Compared with the normal side, the affected hip joints have a longer distance between femoral head and acetabular sphere. The difference of coverage area of the femoral head surface and femoral head volume between the affected and normal sides was bigger compared with the preoperative model, respectively. The changes in the acetabular radius and the area of the surface were not apparent, pre-, and post-operatively. The displacement was mainly on superior and lateral superior portions of the femoral head where the stresses were concentrated.ConclusionCombined pelvic and femoral osteotomies could effectively improve the superior and superior–posterior area of acetabulum containment with increased femoral head volume. CAD model and shape difference analysis can provide a better understanding of deformations of LCPD and more information for surgical planning and evaluation of treatment outcomes.

Surgical hip dislocation with relative femoral neck lengthening and retinacular soft-tissue flap for sequela of Legg-Calve-Perthes disease.

ObjectiveCorrection of post-LCP (Legg–Calve–Perthes) morphology using surgical hip dislocation with retinacular flap and relative femoral neck lengthening for impingent correction reduces the risk of early arthritis and improves the survival of the native hip joint.IndicationsTypical post-LCP deformity with external and internal hip impingement due to aspherical enlarged femoral head and shortened femoral neck with high riding trochanter major without advanced osteoarthritis (Tönnis classification ≤ 1) in the younger patient (age < 50 years).ContraindicationsAdvanced global osteoarthritis (Tönnis classification ≥ 2).Surgical techniqueBy performing surgical hip dislocation, full access to the hip joint is gained which allows intra-articular corrections like cartilage and labral repair. Relative femoral neck lengthening involves osteotomy and distalization of the greater trochanter with reduction of the base of the femoral neck, while maintaining vascular perfusion of the femoral head by creation of a retinacular soft-tissue flap.Postoperative managementImmediate postoperative mobilization on a passive motion device to prevent capsular adhesions. Patients mobilized with partial weight bearing of 15 kg with the use of crutches for at least 8 weeks.ResultsIn all, 81 hips with symptomatic deformity of the femoral head after healed LCP disease were treated with surgical hip dislocation and offset correction between 1997 and 2020. The mean age at operation was 23 years; mean follow-up was 9 years; 11 hips were converted to total hip arthroplasty and 1 patient died 1 year after the operation. The other 67 hips showed no or minor progression of arthrosis. Complications were 2 subluxations due to instability and 1 pseudarthrosis of the lesser trochanter; no hip developed avascular necrosis.

Непосредственные изменения пульсового кровенаполнения в суставных концах подвздошной и бедренной костей после их туннелирования при болезни Пертеса

Introduction In Perthes disease of stage 1 to 2, intraosseous pressure (IOP) of the tissue fluid in the head of the femur due to disorders of the venous outflow increases, the microvasculature is compressed and pulse blood supply is limited. To eliminate secondary circulatory insufficiency, the proximal femur and the supra-acetabular region of the ilium were perforated with wires, and differences in the pulse wave of blood filling in the femoral head associated with the order of perforation of the articular ends of the bones were revealed. Purpose To determine the dependence of the pulse wave of blood filling in the femoral head on the sequence of drilling of the supra-acetabular region of the ilium and the proximal femur in patients with Perthes disease. Material and methods A pulse wave of blood filling in the intraosseous tissues was recorded in 47 patients, aged 6-9 years, using rheovasography. In 6 patients, the supra-acetabular region of the ilium was perforated, then the proximal femur; in 41 patients the sequence was vice versa. Results In the hip joint, perforation of the articular end of one bone leads to post-traumatic angiospasm in the articular ends of both bones, and pulse blood supply decreases. However, by the initial perforation of the proximal end of the femur, the pulse blood supply to the tissues of the femoral head increases, and subsequent drilling of the supra-acetabular region of the ilium contributes to its additional increase. Taking into account the initially increased IOP in the femoral head, it was concluded that perforation leads to decompression of its microcirculatory bed, and pulse blood filling increases, and post-traumatic angiospasm does not develop. Conclusion In Perthes disease, the femoral head should be drilled first to decompress its microvasculature, then the supra-acetabular region of the ilium to redistribute blood circulation and further increase blood flow to the femoral head.

Proximal femoral varus osteotomy in Legg-Calve-Perthes disease

OperationszielDie proximale femorale Varisationsosteotomie (PVO) ist eine chirurgische Technik zur Rezentrierung des Hüftkopfes, sofern es bspw. im Rahmen der ablaufenden Legg-Calvé-Perthes(LCPD)-Krankheit zur Subluxation gekommen ist.IndikationenBis anhin existieren keine einheitlichen Indikationskriterien für die Containment-Therapie bei LCPD-Patienten. Einzelne, für die Deformitätsentwicklung prädiktive radiologische Faktoren, Alter bei Diagnosestellung oder Symptombeginn und Klassifikationen, welche die Pathomorphologie des Femurkopfes bezogen auf die Nekrose beschreiben, können die Indikationsstellung erleichtern.KontraindikationenDie absolute Kontraindikation stellt die Entwicklung eines Scharniergelenkes dar (Hinge-Abduktion). Bleibt der Femurkopf in einer Abduktionsröntgenaufnahme von 20° auch in Abwesenheit einer Hinge-Abduktion dezentriert oder besteht ein Total-Kopf-Befall, ergibt sich ebenfalls eine Kontraindikation. Relativ kontraindiziert ist die PVO bei Kindern mit Beginn der Erkrankung < 6 Jahren, in der Lateral-Pillar-Klassifikation Gruppe A soiwe bei I und II nach Catterall.OperationstechnikLateraler Standardzugang zum proximalen Femur. Platzieren des Anteversions-K-Drahtes ventral des Schenkelhalses. Weitere K-Drähte werden parallel mithilfe von Positionierinstrumenten in den Schenkelhals eingebracht. Der optimale Bereich für die Osteotomie wird aufgesucht. Für die Vereinfachung der Manipulation des distalen Fragments und als Referenz für die Derotation werden am Femurschaft weitere K‑Drähte eingebracht. Nach Femurosteotomie erfolgt proximales Fixieren der Platte durch sukzessives Auswechseln der K‑Drähte gegen winkelstabile Schrauben. Die interfragmentäre Kompression erzeugt eine exzentrisch positionierte Kortikalisschraube im mittleren distalen Plattenloch. Die weitere distale Fixation der Platte erfolgt mit winkelstabilen Schrauben. Auswechseln der Kortikalisschraube gegen eine weitere winkelstabile Schraube. Alternativ zur hier beschriebenen winkelstabilen Technik wurde früher meist mittels Winkelplatte korrigiert.WeiterbehandlungMobilisation unter Abrollbelastung an 2 Gehstöcken über 6 Wochen. Röntgenkontrolle und bei genügender Knochenkonsolidation Steigerung der Belastung. Implantatentfernung nach 9 bis 12 Monaten. Rückkehr zum Sport ab 3 Monaten.ErgebnisseDie PVO ist eine in der Behandlung von LCPD nahezu seit 60 Jahren angewendete und weltweit etablierte chirurgische Technik. Durch ein stetig wachsendes Verständnis der Grunderkrankung wird einerseits die Indikationsstellung für operative Interventionen optimiert. Andererseits tragen neue Implantate zur Verbesserung der klinisch-radiologischen Resultate und Verringerung von Komplikationen während und nach Operation bei.

Mid-Long-Term Outcomes of Surgical Treatment of Legg-Calvè-Perthes Disease: A Systematic Review.

Background: Legg–Calvè–Perthes disease (LCPD) is a common childhood disease that usually occurs in 4- to 12-year-old children. Surgical treatment consists of femoral, pelvic, or combined osteotomies. This comprehensive review aimed to investigate the mid- and long-term outcome of the surgical treatment. Methods: A systematic review of PubMed, Science Direct, and MEDLINE databases was performed by two independent authors, using the keywords “outcome”, “surgical treatment”, “pelvic osteotomy”, “femoral osteotomy”, and “Legg–Calvè–Perthes disease” to evaluate studies of any level of evidence that reported the surgical outcome of LCPD. The result of every stage was reviewed and approved by two senior investigators. Results: A total of 2153 articles were found. At the end of the screening, we selected 23 articles eligible for full-text reading according to the inclusion and exclusion criteria. Our analysis showed that the main prognostic factors for surgical outcome in patients with LCPD are the age at onset and the degree of initial disease severity. Conclusions: Surgical treatment in patients older than 6 years has excellent results in Herring B and B/C hips and poor results in Herring C hips, with a slight advantage for patients between 6 and 8 years old.

Prevalence of Cam-Type Femoroacetabular Impingement Morphology in Hip Joint of Asymptomatic Thai Population

Objective: To determine the prevalence of cam-type femoroacetabular impingement (FAI) in the hip joints of asymptomatic Thai individuals using increased alpha angle of more than 55° on computed tomography (CT) images. Materials and Methods: The prospective study was conducted between 2019 and 2021. CT images of the 226 hip joints with no history of hip pain within three months prior to CT, no history of congenital dysplasia, Perthes disease, slipped capital femoral epiphysis, hip fracture, hip surgery, and inflammatory arthropathy, negative anterior impingement test, and no CT findings of osteoarthritis were evaluated. Alpha angles were measured in the axial oblique and radial planes at 12 o’clock, 1 o’clock, 1:30 o’clock, 2 o’clock, and 3 o’clock. Alpha angles of more than 55° were considered cam-type FAI morphology. Results: The prevalence rates of cam-type FAI morphology using increased alpha angles of more than 55° measured on axial oblique and radial plane images at 12 o’clock, 1 o’clock, 1:30 o’clock, 2 o’clock, and 3 o’clock were 0.4%, 0%, 4.9%, 8.4%, 8.0%, and 1.8% respectively. Cam-type morphology was common in the anterosuperior aspect of the femoral head-neck junction. The prevalence of cam-type morphology was significantly higher in men than in women. Conclusion: The range of prevalence rates of cam-type FAI morphology are between 0 to 8.4%. The prevalence is different in each image plane and location of the femoral head-neck junction. The prevalence of cam-type morphology in the present study differed from those in the previous studies conducted in other countries, which may be caused from variations in race and ethnicity. Keywords: Prevalence; Cam-type Femoroacetabular Impingement (FAI); Alpha angle; Computed tomography (CT)

The effect of proinflammatory cytokine inhibtors on the course of aseptic necrosis of the femoral head in a model experiment

BACKGROUND: One of the most relevant areas of study of Perthes disease is the search and scientific justification of new targets for the treatment of osteodestructive processes. At the same time, an important link in the regulation of bone homeostasis is the cytokine system that affects the processes of differentiation and activation of osteoclasts through the RANK-RANKL-OPG signaling pathway. Inhibition of the biological action of proinflammatory cytokines in the early stages of aseptic necrosis is a promising direction in the study of antiresorptive therapy.&#x0D; АIM: To assess the effectiveness of monoclonal blockers of proinflammatory cytokines in the treatment of aseptic necrosis of the femoral head in a model experiment on Wistar rats.&#x0D; MATERIALS AND METHODS: A model experiment was performed on small animals (24 Wistar rats). All animals underwent surgical induction of aseptic necrosis of the femoral head. The rats were divided into four groups: group 1 did not receive treatment, group 2 were administered a monoclonal IL-6 blocker, group 3 was administered a TNF binding inhibitor, and group 4, a monoclonal IL-1 blocker. Moreover, histological, X-ray, biochemical, and immunological studies were equally performed.&#x0D; RESULTS: We revealed the influence of monoclonal blockers of the biological action of proinflammatory cytokines on the processes of osteogenesis during the manifestation of aseptic necrosis of the femoral head. The most favorable outcomes of the course of aseptic necrosis of the femoral head in the form of greater preservation of the cartilaginous, bony structure were obtained in rats treated with a monoclonal blocker of the proinflammatory cytokine, IL-6.&#x0D; CONCLUSIONS: Genetically engineered biological agents of receptor blockers of proinflammatory cytokines affect aseptic inflammation, especially during osteodestruction. Further studies of the properties of the IL-6 monoclonal blocker is a promising aspect in the study of its effect on bone metabolism disorders in osteolysis.

Effect of Postoperative Femoral Neck Shaft Angle on Femoral Head Sphericity Following Proximal Femoral Osteotomy in Legg-Calve-Perthes Disease.

Herein, we aimed to examine the relationship between the postoperative neck shaft angle (NSA) and the Stulberg outcome at skeletal maturity in patients with Legg-Calvé-Perthes disease (LCPD) who underwent proximal femoral varus osteotomy (PFVO) and to determine the optimal angle of varization. In this retrospective study, we analyzed the data of 90 patients aged older than 6 years at the time of diagnosis with LCPD who underwent PFVO at our institution between 1979 and 2014. Univariate and multivariate logistic regression analyses were used to examine the effects of variables on the sphericity of the femoral head at skeletal maturity, including the age at onset, sex, stage at operation, extent of epiphyseal involvement and epiphyseal collapse, presence of specific epiphyseal, metaphyseal, and acetabular changes, and postoperative NSA. The sphericity of the femoral head on the final plain follow-up radiographs of the hip joint at skeletal maturity was assessed using the Stulberg classification. Cases of spherical femoral head (Stulberg I or II) were rated as good, whereas those of ovoid or flat femoral head (Stulberg III, IV, or V) were rated as bad. The mean age at diagnosis was 7.93 (range, 6.0-12.33) years. The average follow-up period was 10.11 (range, 5.25-22.92) years. The pre and postoperative mean NSAs were 137.31±6.86 degrees (range, 115.7-158 degrees) and 115.7±9.83 degrees (range, 88.6-137.6 degrees), respectively. The age at diagnosis, lateral pillar classification, and postoperative NSA were found to be closely related to the sphericity of the femoral head at skeletal maturity. Patients with a postoperative NSA of <105 degree or more than 125 degree were less likely to have a spherical femoral head. Our study showed that patients with a postoperative NSA between 105 and 125 degrees were more likely to have a spherical femoral head. When performing PFVO in patients with LCPD, reasonable varus angulation of PFVO should be taken into consideration for the success of the operation. Level III retrospective cohort study.

Intraarticular hip preservation procedures in healed Perthes disease: a systemic review and meta-analysis

Background: There is limited data about surgical options in treatment of healed Perthes disease. The authors conducted this systematic review and meta-analysis to compare two newly described surgical techniques: femoral head reduction osteotomy (FHRO) and relative femoral neck lengthening (RFNL) in the management of healed Perthes disease in terms of efficacy and complications. Methods: This systematic review and meta-analysis examined controlled and noncontrolled studies that compared FHRO and RFNL. The authors searched the Medline database via PubMed, EMBASE, and Cochrane Library for studies published between January 2000 and February 2021. Results: Fourteen studies that assessed RFLN and five studies that assessed FHRO were examined. The FHRO group demonstrated better improvement in the Harris Hip Score (HHS) than RFLN. The RFNL group showed better improvement than the FHRO group regarding flexion and internal rotation degree. The incidence of postoperative pain and postoperative stiffness was higher in the FHRO group than in the RFNL group. In the FHRO group, 28 patients with postoperative complications were reported (59.5%) versus 72 patients in the RFNL (16.4%). Conclusion: FHRO and RNFL are effective and safe modalities for post-Perthes sequelae. However, the postoperative clinical outcomes were observed to be in favor of RFNL, with less incidence of postoperative complication, compared to the FHRO. Moreover, the FHRO group needed more secondary acetabular procedures than the RFNL group. On the other hand, FHRO showed observed greater improvements in radiographic coverage indices. Level of Evidence: Level III.

Osteoid Osteoma of the Proximal Femur: Pitfalls in Diagnosis and Performance of Open Surgical Resection.

AimsProximal femoral osteoid osteoma (OO) is extremely easy to be misdiagnosed or missed. The purpose of this study was to retrospectively analyze the clinical data of patients with proximal femoral OO in order to determine the clinical manifestation and imaging characteristics of the disease, so as to provide help for the preoperative diagnosis and clinical treatment of proximal femoral OO.MethodsThis was a retrospective study involving 35 patients with proximal femoral OO admitted into our hospital from January 2015 to January 2021. The baseline characteristics of the participants included; 24 males and 11 females, aged between 13 and 25 (mean 16.2) years old, and the course of the disease was 1 to 14 (mean 6.3) months. We used previous medical experience records of the patients to analyze for the causes of misdiagnosis. Moreover, we compared the difference between preoperative and postoperative treatment practices in alleviating pain in OO patients and restoring hip function. Follow-ups were carried out regularly, and patients advised to avoid strenuous exercises for 3 months.ResultsWe followed up 35 patients (25 intercortical, 4 sub-periosteal, and 6 medullary) for an average of 41.4 months. We found that 15 patients (42.9%) had been misdiagnosed of synovitis, perthes disease, osteomyelitis, intra-articular infection, joint tuberculosis and hip impingement syndrome, whose average time from symptoms to diagnosis were 6.3 months. Postoperative pain score and joint function score improved significantly compared with preoperative, and complications were rare.ConclusionOpen surgical resection constitutes an effective treatment for proximal femoral OO by accurately and completely removing the nidus. Wrong choice of examination, and the complexity and diversity of clinical manifestations constitutes the main reasons for the misdiagnosis of proximal femoral OO.