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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

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.

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 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

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

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

J Pediatr Orthop 2022 Feb;42(2):e163-e167

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

Background: Treatment of Legg-Calvé-Perthes disease (LCPD) aims to preserve the spherical shape of the femoral head. The deformity index (DI) <0.3, measured 2 years from disease onset, is a surrogate measure that predicts that the femoral head will be Stulberg class I or II at skeletal maturity. Read More

J Pediatr Orthop B 2022 Jul 4;31(4):350-358. Epub 2022 Jan 4.

Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

The epiphyseal height and metaphyseal width ratio estimated lateral pillar involvement with limited generalizability among various interpreters. The aim of the study was to evaluate the reliability and the validity of height-width ratio measurement in Perthes disease among interpreters of different experience levels. A cross-sectional study was conducted between 2019 and 2020. Read More

Injury 2022 Feb 20;53(2):615-619. Epub 2021 Dec 20.

University of Utah, Department of Orthopaedic Surgery, Salt Lake City, Utah, USA.

Background: An understanding of femoral anteversion and neck-shaft angle (NSA) is essential to deliver optimal orthopaedic surgical care. Despite the importance, there is little research examining the relationship between femoral anteversion and the NSA in an adult population. This study sought to determine if there is a correlation between femoral neck shaft angle and version in skeletally mature adults using computed tomography (CT) scanograms. Read More

J Child Orthop 2021 Oct;15(5):496-502

Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Purpose: Ultrasound has been used to diagnose hip dysplasia in neonates and to screen until the end of their first year. For older children, femoral head containment disorders such as developmental dysplasia of the hip, Legg-Calvé-Perthes disease or cerebral palsy are usually diagnosed with plain radiographs. The aim of the present study was to evaluate ultrasound in comparison with radiographic imaging in children up to age 12 years and to determine reference values for sonographic containment parameters. Read More

Bone Joint J 2021 Dec;103-B(12):1815-1820

Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.

Aims: The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes' disease.

Methods: A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. Read More

J Pediatr Orthop 2022 Feb;42(2):e154-e162

Department of Pediatric Orthopaedics, BeiJing JiShui Tan Hospital, Beijing, China.

Purpose: Triple pelvic osteotomy (TPO) is often performed to improve femoral head coverage, correct deformity, and stabilize the hip joint in a variety of pediatric orthopaedic conditions. After the TPO was first reported, many modifications were developed to simplify or improve the procedure, however, because of the specific anatomy with several critical nerves and vessels passing through the approaches, extensive exposure and prolonged intraoperative fluoroscopy are often required for TPO. This report introduces a novel, minimally-invasive surgical approach that minimizes the time of intraoperative fluoroscopy and size of the surgical incision, and reviews our experience. Read More

Radiol Clin North Am 2022 Jan;60(1):149-163

Radiology Department, University of Central Florida, Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL 32827, USA. Electronic address:

Hip disorders are a wide range of conditions commonly affecting patients in the pediatric age group. Reaching an accurate diagnosis of these conditions in children may be challenging. The optimal use of image modalities in the approach of a child with possible hip pathology is essential, which allows radiologists and clinicians to narrow the differential diagnosis and reach a definitive diagnosis, which can consequently result in early and appropriate interventions leading to improved outcomes. Read More

Acta Orthop Belg 2021 Jun;87(2):263-268

Current imaging guidelines in Belgium advise a systematic X-ray screening of the hips after an episode of transient synovitis of the hip, in order to detect Perthes disease. The aim of this study was to analyze whether systematic radiological screening is necessary for all children or whether the X-ray indication could be guided by clinical symptoms. A retrospective single center study including all children with the diagnosis of transient synovitis of the hip between 2013 and 2018 was performed. Read More

J Pediatr Orthop 2021 Oct;41(9):e768-e773

Departments of Orthopedic Surgery.

Background: The aim was to assess the long-term radiographic outcomes of patients with Legg-Calvé-Perthes disease following an early proximal femoral osteotomy (PFO) performed in avascular necrosis stage or early fragmentation stage.

Methods: In this retrospective study, we analyzed data of 65 patients aged above 6 years at the time of diagnosis with unilateral Legg-Calvé-Perthes disease, following early PFO performed at our institution between 1979 and 2013. We observed the presence of bypassing fragmentation stage, which was classified into complete and incomplete. Read More

J Pediatr Orthop 2021 Oct;41(9):e780-e786

Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children.

Background: Assessing the severity of Legg-Calve-Perthes disease is important for treatment decision-making and determining prognosis. Perfusion magnetic resonance imaging (MRI) scans have improved our ability to assess femoral head hypoperfusion, and the use of an image analysis software called HipVasc (Scottish Rite for Children, Dallas TX) has allowed precise quantification for research purposes. In the clinical setting, using HipVasc software is not practical, and visual estimation is used to assess hypoperfusion. Read More

Sci Rep 2021 08 13;11(1):16506. Epub 2021 Aug 13.

Department of Orthopedics, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, China.

The acetabular retroversion has a moderate incidence of 31-60% in all patients of the Perthes disease. It might be caused by posterior wall dysplasia based on recent animal researches. However, some studies support that hemipelvic retroversion is the main factor for the acetabular retroversion. Read More

BMC Pediatr 2021 08 12;21(1):339. Epub 2021 Aug 12.

First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou , China.

Background: Perthes disease (Legg-Calvé-Perthes, LCP) is a self-limited and non-systemic disease occurring in the femoral heads of children, which is mainly manifested as an ischemic necrosis of the femoral head epiphysis, leading to subchondral ossification injury of the femoral head.

Case Presentation: Here we report a case of 11-year-old child with long-term use of high-dose glucocorticoids. With MRI examination finding the epiphyseal necrosis of right humeral head, femur and tibia, and X-ray examination finding bilateral femoral head necrosis, the child was diagnosed as Perthes disease based on his clinical and imaging data. Read More

Eur Rev Med Pharmacol Sci 2021 Aug;25(15):4875-4894

Department of Orthopaedic Surgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, U.P, India.

This meta-analysis is aimed to analyze the efficacy of bisphosphonates in the management of Perthes disease. A total of 8 animal and 7 human studies have been shortlisted for this analysis. In human studies, common variables for pain, Harris Hip Score (HHS), propensity for femoral head collapse, and total hip arthroplasty (THA), were assessed. Read More

J Pediatr Orthop 2021 Oct;41(9):e774-e779

Scottish Rite for Children, Dallas, TX.

Background: The etiology of Legg-Calvé-Perthes disease (LCPD) remains unknown; however, interruption of medial circumflex femoral artery (MCFA) supply to the femoral head is the key pathogenic factor. The main purpose of this study is to determine the feasibility of using magnetic resonance angiography (MRA) to evaluate the course of the MCFA in the normal and affected hips of patients with unilateral LCPD.

Methods: We analyzed 24 patients with unilateral LCPD using a time-resolved imaging of contrast kinetics magnetic resonance angiography (TRICKS-MRA). Read More

BMJ Case Rep 2021 Jul 23;14(7). Epub 2021 Jul 23.

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

Perthes disease and slipped capital femoral epiphysis (SCFE) in the same child is a rare occurrence. A 7-year-old boy with the left hip Perthes' disease was managed with femur osteotomy. The femur head healed with a spherical congruent hip. Read More

Acta Reumatol Port 2021 Apr-Jun;46(2):186-188

Pediatric and Young Adult Rheumatology Unity, Centro Hospitalar Universitário São João, Porto, Portugal.

We report a case of Trichorhinophalangeal syndrome type I (TRPS1) in a 16-year-old boy who was referred due to painless finger deformities over the last year. Legg-Calvé-Perthes disease (LGP) had been diagnosed at age 7 and required surgical treatment at age 12. Parents were healthy and non consanguineous; there was family history of pectus carinatum of maternal lineage. Read More

Br J Sports Med 2021 Nov 19;55(21):1212-1221. Epub 2021 Jul 19.

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Background: Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. Read More