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Developing Medical Therapy for Legg-Calvé-Perthes’ Disease

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Osteonecrosis

Abstract

Legg-Calvé-Perthes’ disease (LCPD) was recognized as a separate disease entity from tuberculosis over 100 years ago by Drs. Legg from the USA [1], Calvé from France [2], and Perthes from Germany [3]. Despite research efforts to improve the knowledge base for this pediatric idiopathic hip disorder, LCPD remains one of the most controversial conditions in pediatric orthopedics. While two prospective multicenter studies [4, 5], meta-analyses [6, 7], and some large retrospective studies [8–10] provide clinically valuable information about the outcomes of current operative and nonoperative treatments for LCPD, the optimal way to treat this condition remains elusive. These studies show that the success rates of current treatments, including a femoral varus osteotomy and the Salter innominate osteotomy, in producing a round femoral head (Stulberg I or II hips) range from 40 to 60 % [4, 5] in those children with the onset of the disease after age 8. These results point to the clinical need to develop more effective treatments including biological treatments to specifically target the pathological processes contributing to the femoral head deformity and the poor bone healing. This chapter discusses the experimental evidence for using bisphosphonate therapy to treat LCPD and the potential limitations of bisphosphonate therapy.

Disclosure

Dr. Kim has previously received research grants from Roche Pharmaceutical (Indianapolis, IN, USA).

Dr. Little has previously received consultancy fees from Novartis Corp (East Hanover, NJ, USA).

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Authors and Affiliations

  1. Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX, 75219, USA

    Harry K. W. Kim

  2. Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Harry K. W. Kim

  3. Department of Orthopaedic Research and Biotechnology, The Children’s Hospital at Westmead and University of Sydney, Westmead, NSW, Australia

    David G. Little

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  1. Harry K. W. Kim
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Correspondence to Harry K. W. Kim .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Kyonggi-do, Korea, Republic of (South Korea)

    Kyung-Hoi Koo

  2. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

    Michael A. Mont

  3. Department of Orthopaedic Surgery, Department of Orthopaedic Surgery, Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Lynne C. Jones

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Kim, H.K.W., Little, D.G. (2014). Developing Medical Therapy for Legg-Calvé-Perthes’ Disease. In: Koo, KH., Mont, M., Jones, L. (eds) Osteonecrosis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35767-1_62

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