Clinical Orthopaedics and Related Research®

, Volume 470, Issue 9, pp 2369–2375 | Cite as

Environmental Tobacco and Wood Smoke Increase the Risk of Legg-Calvé-Perthes Disease

  • Anjali Benjamin Daniel
  • Hitesh Shah
  • Asha Kamath
  • Vasudev Guddettu
  • Benjamin JosephEmail author
Symposium: Legg-Calvé-Perthes Disease: Where Do We Stand After 100 Years?



The etiology of Legg-Calvé-Perthes disease (LCPD) remains unknown. A few studies have suggested passive smoke inhalation may be a risk factor, although the association is not confirmed and a causal relationship has not been established.


We therefore undertook this study to confirm an association between environmental tobacco smoke, firewood smoke, and socioeconomic status and the risk of LCPD.


We prospectively recruited 128 children with LCPD and 384 children attending the hospital for other orthopaedic complaints. The control subjects were frequency-matched with the cases by age and gender. Conditional logistic regression was used to assess the association between the exposures and risk of LCPD.


The main risk factors for LCPD were indoor use of a wood stove (adjusted odds ratio [OR], 2.56) and having a family member who smoked indoors (adjusted OR, 2.07). Children from the middle socioeconomic group appeared to be at a greater risk of developing LCPD (adjusted OR, 3.60).


This study provides further evidence that environmental tobacco smoke is associated with an increased risk of LCPD. Exposure to wood smoke also appears to be a risk factor. However, it remains unclear why there are profound differences in the incidence of the disease between regions when the prevalence of smoking is comparable and why bilateral involvement and familial disease are infrequent.

Level of Evidence

Level III, case-control study. See the Guidelines for Authors for a complete description of levels of evidence.


Environmental Tobacco Smoke Conditional Logistic Regression Wood Smoke Wood Stove Prenatal Maternal Smoking 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We gratefully acknowledge the statistical advice and guidance of Dr Sreekumaran Nair, Head of the Department of Statistics, Manipal University, and the valuable comments of Professor Andrew J. Hall, Professor of Epidemiology, London School of Hygiene and Tropical Medicine.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Anjali Benjamin Daniel
    • 1
  • Hitesh Shah
    • 2
  • Asha Kamath
    • 1
  • Vasudev Guddettu
    • 3
  • Benjamin Joseph
    • 2
    Email author
  1. 1.Department of Community MedicineKasturba Medical CollegeManipalIndia
  2. 2.Paediatric Orthopaedic Service, Department of OrthopaedicsKasturba Medical CollegeManipalIndia
  3. 3.Department of StatisticsManipal UniversityManipalIndia

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