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Conservative versus surgical treatment of late-onset Legg-Calve-Perthes disease: a radiographic comparison at skeletal maturity.
MedLine Citation:
PMID:  19308608     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Late-onset Legg-Calve-Perthes disease (LCPD; i.e., disease onset after 8 years) has been associated with a more aggressive course and poorer long-term outcomes. The optimal treatment method of LCPD is still controversial, especially in this late-onset patient population. The purpose of this study was to evaluate the radiographic outcomes at the end of skeletal maturity in a cohort of patients with late-onset LCPD, comparing the results between conservative and surgical treatment.
METHODS: We performed a retrospective comparative study of all 371 patients with LCPD seen at a single institution during a 30-year period. Children younger than 9 years of age at disease onset, bilateral cases, and children that had not reached skeletal maturity at last follow-up were excluded. Clinical data was collected from chart review and radiographs were staged according to the Waldenstrom and Catterall classifications. Patients treated conservatively (adductor tenotomy, bracing and physical therapy, or physical therapy alone) were compared to those treated with more extensive surgery (varus femoral osteotomy or Chiari pelvic osteotomy [CPO]). Final radiographic outcomes were based on a modified Stulberg criteria.
RESULTS: Forty-three patients with an average age of 10.8 years and a mean follow-up of 10 years were identified. Twenty-one children received conservative treatment (15 underwent adductor tenotomy, followed by abduction cast or brace and physical therapy; six had only physical therapy) and 22 underwent surgery (16 underwent femoral varus osteotomy and six had CPO). Based on the modified Stulberg criteria, there was no significant difference in radiographic outcome between the surgical and the conservative treatment groups, but there were twice as many patients with a poor result in the conservative group.
CONCLUSION: Late-onset LCPD presents with an extensive head involvement and shorter disease course. While there was no statistical difference between surgical and conservative treatment, there was a trend toward better radiographic outcomes when varus derotational osteotomy was performed early in the disease process.
Authors:
Alexandre Arkader; Wudbhav N Sankar; Romildo Merçon Amorim
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Publication Detail:
Type:  Journal Article     Date:  2008-12-11
Journal Detail:
Title:  Journal of children's orthopaedics     Volume:  3     ISSN:  1863-2521     ISO Abbreviation:  J Child Orthop     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-03-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101313582     Medline TA:  J Child Orthop     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  21-5     Citation Subset:  -    
Affiliation:
Children's Orthopaedic Center, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 W. Sunset Boulevard, Mailstop #69, Los Angeles, CA, 90027, USA, aarkader@chla.usc.edu.
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