, Volume 471, Issue 8, pp 2570-2577
Date: 25 Apr 2013

Can Residual Leg Shortening Be Predicted in Patients With Legg-Calvé-Perthes’ Disease?

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Abstract

Background

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.

Questions/purposes

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.

Methods

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.

Results

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).

Conclusions

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.

The institution of one or more of the authors (H-RS) has received funding from the Korea Healthcare Technology R & D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A110416).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.