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J Orthop Surg (Hong Kong) 2020 Jan-Apr;28(2):2309499020937862

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

This report describes clinical and radiographic characteristics of two pediatric patients with a presumptive diagnosis of subchondral fracture of the femoral head made based on their clinical course and imaging findings. An 8-year-old boy and an 8-year-old girl had subchondral fracture in the femoral head without osteonecrosis, which was verified by contrast-enhanced magnetic resonance imaging. Although complete disappearance of the fracture line was confirmed in the boy, the girl had a residual femoral head deformity after conservative treatment. Read More

J Orthop Sci 2020 Jun 24. Epub 2020 Jun 24.

Department of Othopaedic and Spine Surgery, Fukuoka Children's Hospital, 5-1-1 Kashii Teriha, Higashi-ku, Fukuoka 812-0017, Japan.

Background: Although acetabular dysplasia is a common etiology of osteoarthritis of the hip regardless of the history of developmental dysplasia of the hip (DDH), whether or not corrective surgeries are beneficial for the childhood asymptomatic acetabular dysplasia remains controversial due to a lack of evidence. We conducted a longitudinal study to compare the cartilaginous morphology on childhood magnetic resonance imaging (MRI) and the mature hip morphology of the same patient and to assess the predictive indicators for future acetabular dysplasia.

Methods: A total of 92 unaffected hips (47 unilateral DDH and 45 unilateral Legg-Calvé-Perthes disease) were reviewed for X-ray and MRI findings on childhood (mean age: 6. Read More

Radiol Clin North Am 2020 May;58(3):529-548

Department of Imaging Sciences, Strong Memorial Hospital, Box 648, 601 Elmwood Avenue, Rochester, NY 14642, USA.

Congenital, developmental, and acquired conditions of the pediatric hip frequently present with sequelae in the adult. There is substantial overlap in the end-stage results of these pathologic conditions, including osseous changes, chondral/labral injuries, and premature osteoarthritis. This review discusses the top 10 etiopathogeneses of pediatric hip conditions and presents associated dysmorphisms in the adult on an illustrative, multimodality, case-based template. Read More

Comput Med Imaging Graph 2020 Apr 5;81:101715. Epub 2020 Mar 5.

Department of Orthopaedics and Traumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey. Electronic address:

Medical image segmentation is one of the most crucial issues in medical image processing and analysis. In general, segmentation of the various structures in medical images is performed for the further image analyzes such as quantification, assessment, diagnosis, prognosis and classification. In this paper, a research study for the 2D semantic segmentation of the multiform, both spheric and aspheric, femoral head and proximal femur bones in magnetic resonance imaging (MRI) sections of the patients with Legg-Calve-Perthes disease (LCPD) with the deep convolutional neural networks (CNNs) is presented. Read More

J Pediatr Orthop 2020 Mar;40(3):120-128

Department of Orthopaedic Surgery, Washington University, St Louis, MO.

Background: Osteochondritis dissecans (OCD) is estimated to occur in 2% to 7% of patients with Legg-Calvé-Perthes disease (LCPD). Unstable osteochondral fragments secondary to LCPD may produce mechanical symptoms requiring surgical intervention. Reattachment of the fragment with open reduction and internal fixation (ORIF) may provide good clinical outcomes. Read More

Mymensingh Med J 2020 Jan;29(1):55-59

Dr Neli Rubyat Sanzida Banu, Assistant Professor (Radiology & Imaging), Mymensingh Medical College (MMC), Mymensingh, Bangladesh.

The purpose of this study is to diagnose Legg-Calve-Perthes disease by computed radiography and Magnetic resonance imaging and accurate staging and correlating the findings of these two modalities. Thirty five (35) patients complaining pain in groins and painful walking, after thorough physical examinations were sent to Department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh for computed radiography and Magnetic Resonance Imaging examination. This cross sectional study was conducted in the Department of Radiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2018. Read More

Clin Orthop Relat Res 2020 01;478(1):169-175

J. Haskel, O. Feder, P. Castañeda, NYU Langone Orthopedic Hospital, New York, NY, USA J. Mijares, Shriners Hospital for Children, Mexico City, Mexico.

Background: Greater trochanteric apophyseodesis and isolated trochanteric descent seek to prevent abductor weakness in patients with a hip deformity because of Legg-Calvé-Perthes disease; however, no studies have evaluated radiographic findings or abductor strength in children treated with these procedures.

Questions/purposes: (1) Do children with Waldenström Stage III Legg-Calvé-Perthes disease treated with either isolated greater trochanteric descent or isolated greater trochanteric apophyseodesis achieve improved radiographic findings (Stulberg classification or neck-shaft angle) compared with those who underwent no surgical treatment? (2) Do children treated with one of those procedures achieve greater abductor strength than those who did not have surgery?

Methods: Between 2006 and 2010, we treated 89 children with Waldenström Type III Legg-Calvé-Perthes disease (reossification). Of these, 27. Read More

Ned Tijdschr Geneeskd 2019 10 24;163. Epub 2019 Oct 24.

Amphia Ziekenhuis, Afd. Kinderorthopedie, Breda.

A limping gait pattern in a child is a red flag for every physician until proven otherwise. Among the most common causes are coxitis fugax, infection (septic arthritis, osteomyelitis), Perthes disease, and slipped capital femoral epiphysis, depending on the age of the patient. A high index of suspicion is required because clinical findings are often subtle, and the diagnosis may be present even if initial radiographs are negative. Read More

BMJ Case Rep 2019 Sep 18;12(9). Epub 2019 Sep 18.

Pediatric Rheumatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.

We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to lateral pillar/Herring stage C bilaterally. His disease initially was extremely functionally limiting with expected poor outcome with eventual joint replacement. Read More

Comput Methods Biomech Biomed Engin 2019 Nov 20;22(14):1107-1115. Epub 2019 Aug 20.

Department of Orthopaedic Surgery, University Medical Centre Ljubljana , Ljubljana , Slovenia.

The biomechanical parameters of the hip joint articular surface were analysed in 141 adult hips after Legg-Calve Perthes Disease, and 114 contralateral unaffected hips (controls), by using HIPSTRESS mathematical models. Geometrical parameters, assessed from anteroposterior and axial radiograms, were used as input to models for resultant hip force and contact hip stress. Results confirm previous indications that head enlargement after the Legg-Calve-Perthes Disease compensates the values of hip stress. Read More

Ugeskr Laeger 2019 Jul;181(30)

In this review about perfusion magnetic resonance imaging (pMRI), we consider it to give detailed insight into the distribution of the infarction in the femoral head in the early phase of Perthes disease. The degree of head involvement is closely related to the long-term prognosis, and as early surgical treatment of children with severe head involvement may be beneficial, pMRI is suggested as an examination in older children with early stages of Perthes disease. The use of gadolinium as contrast medium in otherwise healthy children seems safe, but long-term effects are unknown. Read More

J Am Acad Orthop Surg 2020 Jan;28(2):e64-e70

From the Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA (Dr. Grigoryan, Dr. Korcek, and Dr. Nelson); the Department of Orthopedic Surgery, Rambam Academic Hospital, Haifa, Israel (Dr. Eidelman); and the Paley Orthopedic and Spine institute At Saint Mary's Medical Center, West Palm Beach, FL (Dr. Paley).

Introduction: Triple pelvic osteotomy (TPO) involves periacetabular osteotomies of the ilium, ischium, and pubis to reorient the acetabulum. This operation is indicated in certain situations for the treatment of developmental dysplasia of the hip, dysplastic neuromuscular hips, and for containment of the femoral head in cases of Legg-Calvé-Perthes disease.

Methods: This retrospective cohort study compares radiographic outcomes of patients who underwent TPO using two different techniques and describes a novel single-incision direct lateral approach. Read More

Orthopade 2019 Jun;48(6):515-522

Orthopädische Klinik, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.

Diagnostics: Perthes disease remains a challenge for paediatric orthopedic surgeons. X‑ray imaging is still the method of choice for diagnostics and follow-up examination. A more detailed differentiation of Waldenström's classification, especially in early and late fragmentation stages, might be relevant to optimize timing of containment surgery. Read More

Comput Methods Programs Biomed 2019 Jul 1;175:83-93. Epub 2019 Apr 1.

Department of Orthopaedics and Traumatology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey.

Background And Objective: In orthopaedics, hip joint and circular structure of the femoral head can be distorted by a wide variety of hip joint disorders. Hence, automatic detection and segmentation of the femoral head is an important issue in the studies of computerized hip joint segmentation, quantification and assessment. In the proposed study, we need to detect the center coordinates and radius of spheric and aspheric femoral heads automatically in bilateral hip magnetic resonance (MR) images using a new scheme. Read More

J Bone Joint Surg Am 2019 May;101(10):932-938

Department of Orthopedic Surgery (C.C.W., J.S.V., M.J.H., R.T.T., and R.J.S.) and Division of Biomedical Statistics and Informatics (K.C.M.), Mayo Clinic, Rochester, Minnesota.

Background: Periacetabular osteotomy (PAO) is the most common treatment for symptomatic acetabular dysplasia, or developmental dysplasia of the hip (DDH), in skeletally mature patients. The purpose of this multicenter cohort study was to delineate the long-term radiographic natural history of the dysplastic hip following PAO.

Methods: We evaluated all patients undergoing PAO from 1996 to 2012 at 3 academic institutions in the United States. Read More

Am Fam Physician 2019 05;99(10):610-618

Fairview Sports and Orthopedic Care, Blaine, MN, USA.

Apophysitis and osteochondrosis are common causes of pain in growing bones but have differing etiologies and required management. Apophysitis results from a traction injury to the cartilage and bony attachment of tendons in children and adolescents. Most often it is an overuse injury in children who are growing and have tight or inflexible muscle tendon units. Read More

J Orthop Res 2019 08 25;37(8):1784-1789. Epub 2019 Apr 25.

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

Legg-Calve-Perthes disease is characterized by the capital femoral epiphyseal collapse, which occurs more reliably in the anterior quadrant than the more weight-bearing lateral quadrant. The purpose of this study was to determine whether there is a vascular or microstructural predisposition for anterior femoral epiphyseal collapse in Perthes disease. Thirty-two cadaveric proximal femoral epiphyses from 17 subjects (age 4-14 years old) underwent micro-computed tomography at 10-μm resolution. Read More

Orthop Traumatol Surg Res 2019 05 5;105(3):547-550. Epub 2019 Apr 5.

Orthopédie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France.

Background: Outcome prediction at the early sclerotic stage of Legg-Calvé-Perthes disease (LCPD) is valuable to select patients likely to benefit from early surgery. The metaphyseal apparent diffusion coefficient (ADC) ratio correlated significantly with Herring's classification of LCPD in a preliminary study of 49 MRIs, in which values greater than 1.63 were associated with poor outcomes. Read More

Bull Hosp Jt Dis (2013) 2019 Mar;77(1):53-56

Legg-Calve-Perthes disease is a multifactorial process that can lead to debilitating femoral head deformity in children. Management can range from conservative (such as nonweightbearing protocols), bracing (such as A frames), to more invasive measures involving surgical interventions. First described by Axer in 1965, the varus derotational osteotomy (VDRO) has been a staple in the surgical management of Perthes disease. Read More

Orthopade 2019 Apr;48(4):308-314

Orthopädische Klinik, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland.

Pelvic and femoral osteotomies can be a challenge even for experienced orthopedic surgeons. Residual metal may complicate the insertion of the endoprosthesis in some cases. Sometimes, the anatomical modification of the previous osteotomy complicates the total hip replacement. Read More

Eur J Orthop Surg Traumatol 2019 Jul 20;29(5):1043-1047. Epub 2019 Feb 20.

Ege University School of Medicine ARGEFAR, İzmir, Turkey.

The purpose of the current study was to investigate intra- and inter-observer reliability of arthrographic Laredo classification system in Perthes disease. Forty-seven patients were included in this cross-sectional descriptive study. Patients' age, gender, physical findings and hip arthrographs were collected from hospital medical records. Read More

Acta Orthop Traumatol Turc 2019 May 29;53(3):226-229. Epub 2019 Jan 29.

Acıbadem University, School of Medicine, Istanbul, Turkey.

The deformed and enlarged femoral head secondary to hip diseases such as Legg Calve Perthes and Developmental Dysplasia usually causes impingement between the aspherical head and the acetabulum. To restore and reduce the size of enlarged femoral head, a femoral head reduction technique has been described previously. The goal is to obtain a spherical femoral head and to cover the gliding surface with best available cartilage. Read More

Clin Orthop Relat Res 2019 05;477(5):1073-1083

Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Bern, Switzerland.

Background: Correct quantification of femoral torsion is crucial to diagnose torsional deformities, make an indication for surgical treatment, or plan the amount of correction. However, no clear evaluation of different femoral torsion measurement methods for hips with excessive torsion has been performed to date.

Questions/purposes: (1) How does CT-based measurement of femoral torsion differ among five commonly used measurement methods? (2) Do differences in femoral torsion among measurement methods increase in hips with excessive femoral torsion? (3) What is the reliability and reproducibility of each of the five torsion measurement methods?

Methods: Between March and August 2016, we saw 86 new patients (95 hips) with hip pain and physical findings suggestive for femoroacetabular impingement at our outpatient tertiary clinic. Read More

J Magn Reson Imaging 2019 07 17;50(1):106-113. Epub 2018 Dec 17.

Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA.

Background: Legg-Calvé-Perthes disease (LCPD) is a childhood hip disorder thought to be caused by disruption of blood supply to the developing femoral head. There is potential for imaging to help assess revascularization of the femoral head.

Purpose: To investigate whether quantitative susceptibility mapping (QSM) can detect neovascularization in the epiphyseal cartilage following ischemic injury to the developing femoral head. Read More

Orthop J Sports Med 2018 Nov 12;6(11):2325967118807176. Epub 2018 Nov 12.

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA.

Background: The preoperative diagnosis of hip microinstability is challenging. Although physical examination maneuvers and magnetic resonance imaging findings associated with microinstability have been described, there are limited reports of radiographic features. In patients with microinstability, we observed a high incidence of a steep drop-off on the lateral edge of the femoral head, which we have named the "cliff sign. Read More

Acta Orthop Belg 2017 Dec;83(4):617-623

Hip replacement in patients with proximal femoral deformity and end stage arthrosis is technically challenging. The purpose of this study was to measure the subsidence rate of custom femoral stems using EBRA-Femoral Component Analysis (FCA) software, as an indicator of achievement of primary stability. We retrospectively reviewed 14 hips in 12 consecutive patients who underwent this procedure between June 2008 and Feb. Read More

J Med Imaging Radiat Oncol 2018 Oct;62 Suppl 1:137-138

Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.

J Pediatr Orthop B 2019 Mar;28(2):100-106

Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden.

It is unclear how patient-reported outcome in patients with Legg-Calvé-Perthes disease (LCPD) is correlated with radiographic outcome. It was therefore the aim of our long-term follow-up to evaluate the agreement of patient-reported outcome measures (PROM) with radiographic outcome in patients with a history of unilateral LCPD and a femoral head involvement of more than 50%. We further investigated to what extent the functional outcome (range of motion and Trendelenburg sign) correlates with PROM and radiographic outcome. Read More

J Am Anim Hosp Assoc 2018 Nov/Dec;54(6):e54603. Epub 2018 Oct 1.

From the Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia (I.R.); and Athens Area Humane Society, Athens, Georgia (J.M.).

A 1 yr old castrated male shih tzu was evaluated for an acute right rear limb lameness and hyphema in the anterior chamber of the right eye. On initial examination, the dog was non-weight bearing on his right rear limb. Ophthalmic examination revealed a centrally located, superficial corneal ulcer in the right eye and blood in the anterior chamber. Read More

J Pediatr Orthop 2018 Nov/Dec;38(10):e577-e583

Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University.

Background: The standard evaluation of epiphyseal involvement in Perthes disease is lateral pillar classification. However, it needs to be compared with contralateral normal hip leading to limited use in bilateral disease. We, therefore, develop a ratio between epiphyseal height and metaphyseal width of affected hips to estimate lateral pillar involvement. Read More

Bone 2018 11 17;116:221-231. Epub 2018 Aug 17.

Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390-8883, USA. Electronic address:

Legg-Calvé-Perthes disease (LCPD) is a childhood form of ischemic osteonecrosis of the femoral head which can produce a permanent femoral head deformity and early osteoarthritis. The femoral head deformity results from increased bone resorption and decreased bone formation during repair and remodeling of the necrotic femoral head. A recent study showed that a pro-inflammatory cytokine, interleukin-6 (IL-6), is significantly elevated in the synovial fluid of patients with LCPD. Read More

Radiology 2018 11 31;289(2):386-395. Epub 2018 Jul 31.

From the Center for Magnetic Resonance Research (C.P.J., L.W., J.M.E.) and Departments of Radiology (C.P.J., L.W., J.M.E.), Veterinary Population Medicine (F.T.), and Veterinary Clinical Sciences (C.S.C.), University of Minnesota, 2021 6th St SE, Minneapolis, MN 55455; Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital, Dallas, Tex (O.A., H.K.W.K.); and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Tex (H.K.W.K.).

Purpose To determine whether quantitative MRI relaxation time mapping techniques can help to detect ischemic injury to the developing femoral head. Materials and Methods For this prospective animal study conducted from November 2015 to February 2018, 10 male 6-week-old piglets underwent an operation to induce complete right femoral head ischemia. Animals were humanely killed at 48 hours (n = 2) or 4 weeks (n = 8) after the operation, and the operated and contralateral-control femoral heads were harvested and frozen. Read More

J Am Acad Orthop Surg 2018 Aug;26(15):526-536

From Gillette Children's Specialty Healthcare, St. Paul, MN (Dr. Laine and Dr. Novotny), the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Laine), the Division of Orthopaedic Surgery and Sports Medicine, Children's National Health System, Washington, DC (Dr. Martin), Campbell Clinic Orthopaedics, Memphis, TN (Dr. Kelly), the Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, TN (Dr. Kelly), and Le Bonheur Children's Hospital, Germantown, TN (Dr. Kelly).

Since the first description of Legg-Calvé-Perthes disease a century ago, the diagnosis, staging, prognosis, and treatment decisions have been based on plain radiographs. The goal of treatment is prevention of femoral head deformity, yet radiographic prognostic classifications are applied in the fragmentation stage, often after deformity occurs. These classifications are assigned too late in the progression of the disease to maximize the effects of intervention. Read More

J Am Acad Orthop Surg 2018 Aug;26(15):515-525

From Intermountain Healthcare, Salt Lake City, UT (Dr. Wylie), University of Utah, Salt Lake City (Dr. Peters), and University of Utah Hospital, Salt Lake City (Dr. Aoki).

Hip osteoarthritis (OA) exerts a significant burden on society, affecting 3% of Americans aged >30 years. Recent advances in the understanding of the pathoanatomy and pathomechanics of the hip have led to treatment options for young adults with hip pain. Femoroacetabular impingement, specifically cam-type femoroacetabular impingement, hip dysplasia, and the sequelae of pediatric hip disease can predispose the hip to early OA. Read More

Int Orthop 2019 05 18;43(5):1089-1095. Epub 2018 Jun 18.

Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA.

Purpose: Osteonecrosis of the femoral head (ONFH) typically impacts middle-aged patients who are typically more active and in whom many surgeons would try to delay performing a total hip arthroplasty (THA). This poses a clinical decision-making challenge. Therefore, several options for joint preservation have been advocated, but varying indications and success rates have led to debate on when to use the various procedures. Read More

J Pediatr Orthop 2018 May 29. Epub 2018 May 29.

Department of Orthopaedic Surgery, Washington University, St Louis, MO.

Background: Osteochondritis dissecans (OCD) is estimated to occur in 2% to 7% of patients with Legg-Calvé-Perthes disease (LCPD). Unstable osteochondral fragments secondary to LCPD may produce mechanical symptoms requiring surgical intervention. Reattachment of the fragment with open reduction and internal fixation (ORIF) may provide good clinical outcomes. Read More

J Surg Orthop Adv Spring 2018;27(1):58-63

Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.

Alternative medicine in pediatrics is expanding, with chiropractic now a common choice for families seeking alternative medical care. Currently, there is sparse information in the literature exploring the role of chiropractic in orthopaedic pathology. The objective of this case series is to present pediatric patients who received treatment from chiropractors and orthopaedic physicians as well as to review the respective existing research. Read More

Eur J Orthop Surg Traumatol 2018 Oct 25;28(7):1283-1290. Epub 2018 Apr 25.

Department of Pediatric Radiology, Geneva University Hospitals (HUGe), Rue Willy Donzé 6, 1211, Geneva, Switzerland.

Background: In children older than 5 years with a mild form of Legg-Calvé-Perthes disease, the outcome is difficult to predict. In this study, we retrospectively correlated gadolinium-enhanced subtracted (DGS) and diffusion (DWI) MRI findings to the radiographic assessment according to the Catterall and Herring et al. classifications and to the final score according to Stulberg et al. Read More

Acta Orthop Traumatol Turc 2018 May 26;52(3):216-221. Epub 2018 Mar 26.

Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea. Electronic address:

Objective: Disparity in size between femoral head and acetabulum could promote premature degeneration of the hip joint. The purpose of this study was to report the results of Kawamura's dome osteotomy for acetabular dysplasia due to sequelae of Perthes' disease.

Patients And Methods: Fourteen patients (14 hips) operated between 1999 and 2012 were retrospectively reviewed. Read More

J Pediatr Orthop 2018 Jul;38(6):e300-e304

Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.

Background: Developmental dysplasia of the hip (DDH), which encompasses a wide spectrum of disease from mild dysplasia to frank dislocation, is one of the most common developmental deformities of the lower extremities and one of the leading causes of future osteoarthritis and hip arthroplasty. Legg-Calvé-Perthes disease (LCPD) results from a vascular insult to the growing femoral epiphysis, which in turn can create permanent morphologic changes to the hip joint. Slipped capital femoral epiphysis (SCFE) occurs when the proximal femoral physis fails allowing the epiphysis to displace in relation to the metaphysis. Read More

Instr Course Lect 2018 Feb;67:453-472

Professor, Department of Orthopaedic Surgery, Stanford University, Redwood City, California.

Hip arthroscopy is one of the most rapidly growing areas in orthopaedic surgery because of increased awareness of nonarthritic hip pathologies, advanced imaging modalities, and advanced techniques to reproducibly manage nonarthritic hip pathologies within a deep soft-tissue envelope and a constrained joint. In addition, more academic medical centers are providing residents with education on hip arthroscopy, and many hip preservation fellowships and courses are helping increase awareness of nonarthritic hip pathologies. Nonarthritic hip pathologies currently managed via hip arthroscopy include nonrepairable labral lesions, femoroacetabular impingement, hip instability, and hip fractures. Read More

J Pediatr Orthop 2019 Feb;39(2):e95-e101

Children's Hospital of Philadelphia, University of Pennsylvania Medical School, Philadelphia, PA.

Background: Although hinge abduction is recognized as an important finding in children with Legg-Calvé-Perthes disease, variable diagnostic criteria exist. The purpose of this study was (1) to test the interobserver and intraobserver agreement of the current definition of hinge abduction and (2) to develop consensus regarding key diagnostic features that could be used to improve our diagnostic criteria.

Methods: Four orthopaedic surgeons with subspecialty pediatric hip interest independently assessed 30 randomly ordered cases of Legg-Calvé-Perthes disease. Read More

Clin Orthop Surg 2017 Dec 10;9(4):397-404. Epub 2017 Nov 10.

Department of Orthopaedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.

Background: In a previous study, we reported clinical and radiographic results of our modified Salter innominate osteotomy technique in 16 hips affected by Legg-Calvé-Perthes disease (LCPD) with an average follow-up of 31.8 months. In this study, we present the long-term results of the osteotomy in LCPD patients followed until physeal closure. Read More

Hip Int 2018 May 12;28(3):302-308. Epub 2017 Jan 12.

1 Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon - South Korea.

Introduction: The residual hip deformities after Legg-Calvé-Perthes disease (LCPD) cause mechanical symptoms and are associated with a pathomechanical environment that can feature femoroacetabular impingement (FAI). The aim of this study is to evaluate the clinical and radiological outcomes in residual or healed LCPD after arthroscopic treatment.

Patients And Methods: We retrospectively reviewed patients with LCPD amongst patients with FAI who underwent arthroscopic treatment between January 2009 and June 2013. Read More

Pediatr Radiol 2018 03 27;48(3):350-358. Epub 2017 Nov 27.

Department of Radiology, Vanderbilt University Medical Center, Vanderbilt Children's Hospital, Nashville, TN, USA.

Background: Evaluating postoperative patients with hardware is challenging following surgical intervention for hip maladies such as femoral neck fractures and slipped capital femoral epiphysis (SCFE). These children are at increased risk of developing avascular necrosis, and imaging may be requested to confirm or exclude this diagnosis. Children with Legg-Calvé-Perthes disease can be monitored for restoration of blood flow to the capital femoral epiphysis to guide management and help with prognosis. Read More

J Orthop Sci 2018 Jan 20;23(1):161-167. Epub 2017 Nov 20.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.

Background: The Herring lateral pillar classification is widely used for the classification of Legg-Calvé-Perthes disease, but is not applied at the early stage of Legg-Calvé-Perthes disease because it is typically applied at the late fragmentation stage. The purpose of this study was to investigate the correlation between the early appearance on magnetic resonance imaging of the acetabular labrum and lateral pillar involvement in Legg-Calvé-Perthes disease.

Methods: Non-contrast magnetic resonance images of 26 hips in 25 children with early-stage Legg-Calvé-Perthes disease were retrospectively reviewed. Read More

Orthop Traumatol Surg Res 2018 02 16;104(1S):S107-S112. Epub 2017 Nov 16.

Clinique chirurgicale infantile, hôpital Charles-Nicolle, centre hospitalier universitaire (CHU) de Rouen, 1, rue de Germont, Rouen 76031, France.

Current knowledge of the causes and risk factors of Legg-Calvé-Perthesdisease (LCPD) does not allow effective preventive strategies. The outcome in adulthood is usually good. Hip osteoarthritis rarely develops before 50 years of age. Read More

Hip Int 2018 May 10;28(3):297-301. Epub 2017 Nov 10.

Paediatric Orthopaedic Unit, Paediatric Hospitals of Nice CHU-Lenval, Nice - France.

Introduction: The goal of intervention in Legg-Calvé-Perthes disease (LCPD) is to prevent femoral head deformation by containing the head within the acetabulum. Currently, surgical containment methods are the mainstay of treatment, and pelvic osteotomies have been shown to be successful. They include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy and shelf procedure. Read More

Musculoskelet Surg 2018 Aug 12;102(2):153-157. Epub 2017 Oct 12.

Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Background: Most of the information available about Legg-Calve-Perthes disease (LCPD) at present is gained through imaging modalities including plain radiographs and magnetic resonance imaging (MRI). But the accuracy of MRI in this disease and its predictive value to reveal various intra-articular pathologies is not known. We correlated the findings of MRI with those seen on hip arthroscopy in children with active stage of LCPD. Read More

J Orthop Sci 2018 Jan 2;23(1):156-160. Epub 2017 Oct 2.

Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.

Background: Treatment with a brace is the first choice as conservative treatment via the containment method for Legg-Calvé-Perthes disease (LCPD). The purpose of this study is to evaluate clinical outcomes and influential factors of conservative treatment with the non-weight-bearing abduction brace for LCPD.

Methods: One hundred thirty hips in 130 patients were examined in this study. Read More