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Acta Ortop Bras 2022 15;30(2):e247996. Epub 2022 Apr 15.

Universidade de São Paulo, Medical School, Hospital das Clínicas, Institute of Orthopedics and Traumatology (IOT-HCFMUSP), São Paulo, SP, Brazil.

Many experimental models exist to better understand the necrosis of the femoral head etiology, both in terms of the species variety in which necrosis is induced and in the operative techniques used for treatment.

Objective: This study has two main objectives, the first is to review the literature concerning experimental models of avascular necrosis of the growing femoral head, the second, to demonstrate the experimental pig model's reproducibility using a pilot study.

Methods: This was a bibliographic review to describe the attempts over time to find the best species and technique for induction that would reproduce ischemic necrosis of the growing femoral head in humans. Read More

Musculoskelet Surg 2022 Jun 18. Epub 2022 Jun 18.

Pediatric Orthopedics, Ruth Rappoport Children's Hospital, Rambam Health Care Campus, 8 Haaliya Hashniya Street, 3525408, Haifa, Israel.

Purpose: There is no consensus regarding treatment of Legg-Calve-Perthes disease (LCPD). The most common sequel of the disease is coxa breva and overgrowth of the greater trochanter (GT). Our purpose was to examine the effectiveness of transepiphyseal drilling combined with closure of the GT apophysis in patients with LCPD. Read More

Acta Orthop Traumatol Turc 2022 May;56(3):187-193

Department of Orthopaedics and Traumatology, İstanbul Bilim University, İstanbul, Turkey.

Objective: This study aimed to establish a feasible conservative treatment algorithm for Legg-Calvè-Perthes Disease (LCPD), clarify its limitations, and evaluate the correlations between radiographical and clinical results.

Methods: Patients diagnosed with LCPD and treated conservatively were evaluated retrospectively; 39 hips from 35 patients were included. The treatment protocol consisted of intermittent manual traction, range of motion exercises, activity limitation, bed rest, NSAID (ibuprofen 100mg/5mL), and ASA (100mg/day) during attack periods. Read More

N Engl J Med 2022 06;386(23):e62

Taipei Medical University, Taipei, Taiwan.

Clin Biomech (Bristol, Avon) 2022 May 20;97:105670. Epub 2022 May 20.

University of Duisburg-Essen, Engineering Faculty, Chair of Mechanics and Robotics, Lotharstr. 1, D-47057 Duisburg, Germany.

Background: Until now follow-up- and outcome evaluations in Perthes disease are analysing predominantly subjective results and clinical/radiological parameters. To enlarge the assessment by quantitative, functional aspects a summary measure for overall gait quality would be helpful. Therefore, the objective of this study is to evaluate whether commonly used global gait indices are sensitive to detect gait deviations during the early stages of the Perthes disease. Read More

Osteoarthritis Cartilage 2022 May 26. Epub 2022 May 26.

Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA. Electronic address:

Objective: To determine if the quantitative MRI techniques T2 and T1ρ mapping are sensitive to ischemic injury to epiphyseal cartilage in vivo in a piglet model of Legg-Calvé-Perthes disease using a clinical 3T MRI scanner. We hypothesized that T2 and T1ρ relaxation times would be increased in the epiphyseal cartilage of operated vs contralateral-control femoral heads 1 week following onset of ischemia.

Design: Unilateral femoral head ischemia was surgically induced in eight piglets. Read More

Acta Chir Orthop Traumatol Cech 2022 ;89(2):134-138

Ortopediatri, Pediatric Orthopedic Academy, Istanbul, Turkey.

PURPOSE OF THE STUDY Radiographs are preferred for understanding the deformity and containment in Legg-Calvé-Perthes disease (LCPD), as well as for treatment planning, but plain radiographs provide only static information and are inadequate for dynamic assessment of the joint. Magnetic resonance imaging (MRI) has been shown to be superior to other diagnostic modalities. The aim of this study was to determine the importance of hip MRI in LCPD treatment decision-making processes between pediatric orthopedic surgeons and orthopedic surgery residents. Read More

J Child Orthop 2022 Feb 5;16(1):5-18. Epub 2022 Apr 5.

Division of Paediatric Orthopaedics and Limb Reconstruction, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.

Background: Typical sequelae of Perthes disease and Perthes-like deformities comprise a short femoral neck, aspherical femoral head, and greater trochanteric overgrowth. Morscher's osteotomy aims at restoring the normal extra-articular anatomy, but incapable of restoring a normal head-neck contour with residual impingement. Femoral neck lengthening osteotomy combined with osteochondroplasty through surgical hip dislocation approach was not previously described in the literature. Read More

Rev Esp Cir Ortop Traumatol 2022 May-Jun;66(3):170-175. Epub 2022 Feb 24.

Servicio de Ortopedia Infantil, Hospital Infantil Universitario Niño Jesús, Madrid, España.

Introduction: Several socioeconomic population factors have been related to the aetiology of Legg-Calve-Perthes disease (LCPD), such as its higher incidence in the urban population, living on the periphery of urban centres or residing at a certain latitude with respect to the world equator. The incidence in some other countries is known but the incidence of the process in our environment is unknown an important fact to allocate the social and health resources necessary for the treatment of the disease. Therefore, the aim of the present study is to determine the incidence of LCPD in Health Area 2 of Madrid. Read More

Indian J Orthop 2022 May 20;56(5):867-873. Epub 2022 Jan 20.

Department of Orthopaedic Surgery, BC Children's Hospital, 1D66-4480 Oak Street, Vancouver, BC V6H 3V4 Canada.

Background: The purpose of this study was to examine the evolution of Legg-Calvé-Perthes' disease (LCPD) among children from British Columbia (BC), Canada who were treated non-operatively and to compare the results to a previously conducted study in India.

Methods: This was a retrospective review of patients treated non-operatively for LCPD in BC between 1990 and 2006 compared with a cohort from India. Demographic and treatment information were collected from medical records. Read More

Bone Jt Open 2022 May;3(5):404-414

Department of Orthopedic Research, Scottish Rite for Children, Dallas, Texas, USA.

Aims: Perthes' disease is an uncommon hip disorder with limited data on the long-term outcomes in adulthood. We partnered with community-based foundations and utilized web-based survey methodology to develop the Adult Perthes Survey, which includes demographics, childhood and adult Perthes' disease history, the University of California Los Angeles (UCLA) Activity Scale item, Short Form-36, the Hip disability and Osteoarthritis Outcome Score, and a body pain diagram. Here we investigate the following questions: 1) what is the feasibility of obtaining > 1,000 survey responses from adults who had Perthes' disease using a web-based platform?; and 2) what are the baseline characteristics and demographic composition of our sample?

Methods: The survey link was available publicly for 15 months and advertised among support groups. Read More

Front Pediatr 2022 6;10:835447. Epub 2022 Apr 6.

Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.

Proximal femoral varus osteotomy (PFVO) is a common procedure performed in children with developmental dysplasia of the hip (DDH) and Legg-Calvé-Perthes disease (LCPD). However, the long-term effect on angular deformities of the knees and ankles following PFVO remains controversial. This study investigated the relationship between PFVO and alignment changes in the knee and ankle after the procedure. Read More

J Pediatr Orthop 2022 Jul 21;42(6):e570-e576. Epub 2022 Apr 21.

Former Head of Paediatric Orthopaedic Service, Kasturba Medical College, Manipal, Karnataka, India.

Background: Among a cohort of 402 children with Legg-Calvé-Perthes disease (LCPD), 32 children presented with sclerosis and severe collapse of the entire femoral epiphysis that closely resembled a discus.This study was undertaken to identify the characteristics of children with this form of a "discoid epiphysis," compare them with typical LCPD and ascertain the radiologic outcome of their hips when the disease healed.

Methods: Sequential radiographs of the children were studied to monitor disease evolution. Read More

J Hip Preserv Surg 2021 Aug 21;8(3):240-248. Epub 2021 Aug 21.

Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, Dresden 01307, Germany.

Salter innominate osteotomy (SIO) has been successfully used in the treatment of Legg-Calvé-Perthes disease (LCPD). Recent studies that have raised concerns about acetabular retroversion after SIO have been based on plain radiographs. In order to assess the true acetabular orientation, the present study uses a specific magnetic resonance imaging (MRI) technique. Read More

Arthroplast Today 2022 Jun 4;15:61-67. Epub 2022 Apr 4.

Ziekenhuis Oost-Limburg, Orthopedie, Genk, Belgium.

Background: Total hip replacement (THR) in patients with a history of Legg-Calvé-Perthes disease can be a technically challenging procedure due to the distorted hip morphology. We propose a technique in which THR is preceded by a modified relative femoral neck lengthening (RFNL) procedure. Hereby, we aim to restore the biomechanical parameters. Read More

Bone Joint J 2022 04;104-B(4):510-518

National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.

Aims: The aim of this study was to evaluate the epidemiology and treatment of Perthes' disease of the hip.

Methods: This was an anonymized comprehensive cohort study of Perthes' disease, with a nested consented cohort. A total of 143 of 144 hospitals treating children's hip disease in the UK participated over an 18-month period. Read More

J Pediatr Orthop B 2022 Mar 31. Epub 2022 Mar 31.

Department of Orthopaedic Surgery, Waikato Hospital.

YouTube is an increasingly accessible platform for families to obtain health information from; however, it is unregulated. The aim of this article was to assess the quality, reliability and accuracy of YouTube videos related to three common pediatric hip conditions: development dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes disease. YouTube was searched using a variety of keyword combinations. Read More

Medicine (Baltimore) 2022 Mar;101(11)

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan,Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, 7-426 Morioka-Cho, Obu, Aichi, Japan.

Abstract: Legg-Calvé-Perthes disease (LCPD) presents with chronic nature of inflammation, characterized by prolonged synovitis. So far, no single blood marker has been identified to guide clinicians in estimating the severity and prognosis. Blood neutrophil to lymphocyte ratio (NLR) or systemic immune inflammation index (SII) is a simple indicator of subclinical inflammation. Read More

Int Orthop 2022 Jun;46(6):1441

Children (Basel) 2022 Mar 21;9(3). Epub 2022 Mar 21.

Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstraße 9, 4020 Linz and Altenberger Strasse 96, 4040 Linz, Austria.

Background And Objectives: Reconstruction of the pelvic joint is a common way to address developmental dysplasia of the hip (DDH), as well as neurogenic dislocation of the hip (NDH) and Legg-Calvé-Perthes disease (LCPD) in children. The purpose of this study was to analyze the short-term radiologic outcome after hip reconstructive surgery either treated with sole osteotomy of the femur or in combination with iliac osteotomy in patients with DDH, NDH and LCPD.

Materials And Methods: X-rays of 73 children, aged 2-18 years, with DDH, NDH and LCPD after hip reconstructive surgery were measured retrospectively and compared to the preoperative x-rays concerning various parameters to define hip geometry. Read More

BMJ Case Rep 2022 Mar 17;15(3). Epub 2022 Mar 17.

Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.

Perthes' disease is a rare paediatric condition involving idiopathic avascular necrosis of the femoral head, leading to degenerative hip joint disease. While joint replacement surgery is considered as the definitive surgical choice of managing degenerative hip disease, alternative methods of pain relief are available, especially for young patients, to defer joint replacement to a later date. One method of reducing pain for 18-24 months is cooled radiofrequency ablation (CRFA). Read More

Orphanet J Rare Dis 2022 03 15;17(1):125. Epub 2022 Mar 15.

Department of Morphology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomás, Miguel Hidalgo, C.P. 11340, Mexico City, Mexico.

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. Read More

Orphanet J Rare Dis 2022 03 9;17(1):123. Epub 2022 Mar 9.

Morphology Department, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional (ENCB, IPN), Prolongación de Carpio y Plan de Ayala s/n, Col. Santo Tomás, Miguel Hidalgo, C.P. 11340, Mexico City, Mexico.

Background: Legg-Calvé-Perthes disease (LCPD) is the avascular osteonecrosis of the proximal femoral epiphysis. It is a rare disease of unclear etiology in children, although alterations in coagulation or the collagen gene have been described and could be associated with its etiology. Our objective was to evaluate the following alterations: COL1A1 (rs1107946, rs2412298), COL2A1 (rs121912891 and rs387106558), MTHFR rs1801133, CBS rs115742905, and PT rs1799963 and their relationship with LCPD. Read More

Int Orthop 2022 05 1;46(5):1085-1094. Epub 2022 Mar 1.

Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkoknoi, Bangkok, 10700, Thailand.

Purpose: There are several treatment modalities for Legg-Calvé-Perthes disease (LCPD), self-limiting, avascular osteonecrosis of the femoral head in children. Most treatments focus on containment of the weakened femoral head, but there is no consensus on the best modality for severe LCPD. Therefore, we compared the effectiveness of all treatment modalities for severe LCPD. Read More

Children (Basel) 2022 Feb 18;9(2). Epub 2022 Feb 18.

Department for Orthopaedics and Traumatology, Marienkrankenhaus Soest GmbH, Widumgasse 5, 59494 Soest, Germany.

Background: Surgical hip joint reconstruction may be the method of choice for children and adolescents with developmental dysplasia of the hip (DDH), as well as neurogenic dislocation of the hip (NDH) and Legg-Calvé-Perthes disease (LCPD). Following pelvic surgery, immobilization using a spica cast is considered to be the gold standard, despite the fact that casting may cause complications, such as hygienic problems, skin lesions, neurological deficits, and rigidity of the adjacent joints. An alternative for postoperative immobilization is a foam splint. Read More

Bone Jt Open 2022 Feb;3(2):158-164

Orthopaedic Department, Royal Childrens Hospital, Melbourne, Australia.

Aims: Slipped upper femoral epiphysis (SUFE) has well documented biochemical and mechanical risk factors. Femoral and acetabular morphologies seem to be equally important. Acetabular retroversion has a low prevalence in asymptomatic adults. Read More

J Pediatr Orthop 2022 May-Jun 01;42(5):239-245

Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.

Background: It has been demonstrated that early femoral varus osteotomy (FVO) produces a greater probability of skipping or interruption of epiphyseal fragmentation, thereby shortening the length of fragmentation stage for hips in the active stage of Legg-Calvé-Perthes disease. This "bypassing phenomenon" is thought to effect less disease severity or outcome, whereas it remains to be elucidated whether this phenomenon is specific to early FVO. We sought to investigate the presence and characteristics of the "bypassing phenomenon" following pelvic osteotomy performed in the avascular necrosis or early fragmentation stage as well as its correlation with disease severity and radiographic outcomes. Read More

J Pediatr Orthop B 2022 Mar;31(2):e160-e166

Department of Pediatric Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.

The cause of Legg-Calvé-Perthes disease (LCPD) remains unknown. We propose a new hypothesis that the iliopsoas muscle and/or tendon affects the progression of ischemic necrosis of the femoral head as an anatomical factor. The purpose of this study was to test this hypothesis by measuring the psoas major tendon angle (PMTA) and cross-sectional area (CSA) of the iliopsoas muscle on MRI. Read More

J Pediatr Orthop 2022 Apr;42(4):175-178

Scottish Rite for Children.

Introduction: A recent cadaveric study supported that most immature hips are supplied by the artery of ligamentum teres and suggested this medial vascular source may influence the pattern of revascularization in Legg-Calve-Perthes disease (LCPD). The purposes of this study were to characterize the perfusion pattern of the capital femoral epiphysis and determine the role of the artery of ligamentum teres in early revascularization of LCPD.

Methods: Retrospective review of perfusion magnetic resonance imaging (pMRI) from 64 hips in early stage LCPD (Waldenström stage I to IIa) was performed. Read More

J Pediatr Orthop 2022 Feb;42(2):e168-e173

Department of Pediatric Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education.

Introduction: This study was undertaken to compare the radiologic outcomes of bilateral and unilateral Perthes disease and also to evaluate the outcome of synchronous and metachronous bilateral Perthes disease.

Methods: Of 353 children with Perthes disease followed up from presentation to healing during the last 10 years, 37 had bilateral involvement (11 synchronous and 26 metachronous onset). The radiologic outcomes of each hip of children with bilateral disease were compared with outcomes of 148 children with unilateral disease who were matched for age, sex, and treatment. Read More