Can Residual Leg Shortening Be Predicted in Patients With Legg-Calvé-Perthes’ Disease?
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Although Legg-Calvé-Perthes’ disease (LCPD) is frequently associated with varying degrees of femoral head deformity and leg length discrepancy (LLD), no factors that predict residual shortening have been clearly identified.
We attempted to determine whether (1) the extent of femoral head involvement; (2) varus osteotomy; and (3) patient demographic characteristics are associated with LLD at skeletal maturity in patients with LCPD.
We retrospectively reviewed the records of 168 skeletally mature patients with unilateral LCPD. The mean age at diagnosis was 7 years (range, 2–14 years). The extent of femoral head involvement was determined from the initial radiographs using the Herring lateral pillar and Catterall classifications. LLD was defined as shortening by ≥ 1.0 cm as measured from scanograms. The patient’s sex and the treatment modalities used were also recorded.
LLD ranging from 10 to 38 mm (mean, 19 mm) occurred in 93 (55%) patients and was associated with the extent of femoral head involvement. Varus osteotomy was not associated with residual shortening. The patient’s age at diagnosis did not affect the LLD at skeletal maturity. The strongest predictor of LLD was a lateral pillar classification of B/C or C (odds ratio, 3.5; 95% confidence interval, 1.39–8.79).
The extent of femoral head involvement, but not the patient’s age at diagnosis or sex or the treatment modality, can predict the LLD at skeletal maturity in patients with unilateral LCPD.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Barnes JM. Premature epiphysial closure in Perthes’ disease. J Bone Joint Surg Br. 1980;62:432–437.
- Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.
- Bowen JR, Foster BK, Hartzell CR. Legg-Calve-Perthes disease. Clin Orthop Relat Res. 1984;185:97–108.
- Bowen JR, Schreiber FC, Foster BK, Wein BK. Premature femoral neck physeal closure in Perthes’ disease. Clin Orthop Relat Res. 1982;171:24–29.
- Canavese F, Dimeglio A. Perthes’ disease: prognosis in children under six years of age. J Bone Joint Surg Br. 2008;90:940–945.
- Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg Br. 1971;53:37–53.
- Catterall A. Legg-Calve-Perthes syndrome. Clin Orthop Relat Res. 1981;158:41–52.
- Christensen F, Soballe K, Ejsted R, Luxhoj T. The Catterall classification of Perthes’ disease: an assessment of reliability. J Bone Joint Surg Br. 1986;68:614–615.
- Edgren W. Coxa plana. A clinical and radiological investigation with particular reference to the importance of the metaphyseal changes for the final shape of the proximal part of the femur. Acta Orthop Scand Suppl. 1965:Suppl 84:81–129.
- Eijer H, Podeszwa DA, Ganz R, Leunig M. Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes’ disease. Hip Int. 2006;16:273–280.
- Gower WE, Johnston RC. Legg-Perthes disease. Long-term follow-up of thirty-six patients. J Bone Joint Surg Am. 1971;53:759–768.
- Gross RH. Leg length discrepancy: how much is too much? Orthopedics. 1978;1:307–310.
- Grossbard GD. Hip pain during adolescence after Perthes’ disease. J Bone Joint Surg Br. 1981;63:572–574.
- Grzegorzewski A, Synder M, Kozlowski P, Szymczak W, Bowen RJ. Leg length discrepancy in Legg-Calve-Perthes disease. J Pediatr Orthop. 2005;25:206–209. CrossRef
- Hardcastle PH, Ross R, Hamalainen M, Mata A. Catterall grouping of Perthes’ disease. An assessment of observer error and prognosis using the Catterall classification. J Bone Joint Surg Br. 1980;62:428–431.
- Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. 2004;86:2103–2120.
- Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am. 2004;86:2121–2134.
- Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH. The lateral pillar classification of Legg-Calve-Perthes disease. J Pediatr Orthop. 1992;12:143–150. CrossRef
- Ippolito E, Tudisco C, Farsetti P. The long-term prognosis of unilateral Perthes’ disease. J Bone Joint Surg Br. 1987;69:243–250.
- Karpinski MR, Newton G, Henry AP. The results and morbidity of varus osteotomy for Perthes’ disease. Clin Orthop Relat Res. 1986;209:30–40.
- Kaweblum M, Aguilar MC, Blancas E, Kaweblum J, Lehman WB, Grant AD, Strongwater AM. Histological and radiographic determination of the age of physeal closure of the distal femur, proximal tibia, and proximal fibula of the New Zealand white rabbit. J Orthop Res. 1994;12:747–749. CrossRef
- Keret D, Harrison MH, Clarke NM, Hall DJ. Coxa plana—the fate of the physis. J Bone Joint Surg Am. 1984;66:870–877.
- Kim HK, Herring JA. Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am. 2011;42:285–295, v. CrossRef
- Langenskiold A. Changes in the capital growth plate and the proximal femoral metaphysis in Legg-Calve-Perthes disease. Clin Orthop Relat Res. 1980;150:110–114.
- Laron Z, Axer A, Drezner Z. Growth and development of children with Legg-Calve-Perthes syndrome in Israel. Isr J Med Sci. 1973;9:612–616.
- Leitch JM, Paterson DC, Foster BK. Growth disturbance in Legg-Calve-Perthes disease and the consequences of surgical treatment. Clin Orthop Relat Res. 1991;262:178–184.
- McAndrew MP, Weinstein SL. A long-term follow-up of Legg-Calve-Perthes disease. J Bone Joint Surg Am. 1984;66:860–869.
- Mirovsky Y, Axer A, Hendel D. Residual shortening after osteotomy for Perthes’ disease. A comparative study. J Bone Joint Surg Br. 1984;66:184–188.
- Murphy RP, Marsh HO. Incidence and natural history of ‘head at risk’ factors in Perthes’ disease. Clin Orthop Relat Res. 1978;132:102–107.
- Rosenfeld SB, Herring JA, Chao JC. Legg-calve-perthes disease: a review of cases with onset before six years of age. J Bone Joint Surg Am. 2007;89:2712–2722. CrossRef
- Rowe SM, Moon ES, Song EK, Yoon TR, Kim MS, Cho SB. Residual shortening after Legg-Calve-Perthes disease, focusing on the response of the ipsilateral tibia. J Pediatr Orthop. 2005;25:296–299. CrossRef
- Salter RB, Thompson GH. Legg-Calve-Perthes disease. The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am. 1984;66:479–489.
- Sankar WN, Flynn JM. The development of acetabular retroversion in children with Legg-Calve-Perthes disease. J Pediatr Orthop. 2008;28:440–443. CrossRef
- Schoenecker PL, Stone JW, Capelli AM. Legg-Perthes disease in children under 6 years old. Orthop Rev. 1993;22:201–208.
- Shapiro F. Legg-Calve-Perthes disease: a study of lower extremity length discrepancies and skeletal maturation. Acta Orthop Scand. 1982;53:437–444. CrossRef
- Snow SW, Keret D, Scarangella S, Bowen JR. Anterior impingement of the femoral head: a late phenomenon of Legg-Calve-Perthes’ disease. J Pediatr Orthop. 1993;13:286–289. CrossRef
- Sponseller PD, Desai SS, Millis MB. Abnormalities of proximal femoral growth after severe Perthes’ disease. J Bone Joint Surg Br. 1989;71:610–614.
- Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes’ disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. 2008;90:1364–1371.
- Willner S. Difference in leg length in children with coxa plana during and after treatment using unilateral unloading. Acta Orthop Scand. 1975;46:102–107. CrossRef
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