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Incidence of total hip arthroplasty in patients with Legg-Calve-Perthes disease after conservative or surgical treatment: a meta-analysis

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Abstract

Purpose

This systematic review and meta-analysis aimed to determine the incidence of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) treated conservatively or surgically and factors influencing the incidence of THA.

Methods

Long-term follow-up studies on the conservative or surgical treatments of LCPD from 1950 to 2021 were conducted using six public databases. Articles were screened by two investigators (PRISMA guidelines), and the quality of the included publications (n = 27) was assessed (MINORS criteria). R version 4.2.1 was used for statistical analysis.

Results

The overall incidences of THA were 6.8% and 5.14% in patients who were treated conservatively and surgically, respectively. At disease onset, the incidences of THA were 6.79% and 6.17% after conservative treatment and surgery in patients aged < seven years, respectively, and 16.97% and 3.61% in patients aged > seven years, respectively. The incidences of THA were 4.91%, 5.19%, and 23.18% in patients who were treated conservatively with ≤ 30, 30–40, and > 40 years of follow-up, respectively, and 3.68%, 3.11%, 9.66%, and 17.92% in patients who were treated surgically with ≤ ten, ten to 20, 20–40, and > 40 years of follow-up, respectively. In patients who received conservative treatment, the incidences of THA were 5.79% and 5.29% in patients with Stulberg I–II and III–V, respectively. In surgically treated patients, the incidence of THA was 0% in Stulberg I-II and 8% in Stulberg III-V.

Conclusion

Patients with LCPD had relatively low incidences of THA. The greater the age at disease onset and longer the follow-up, the higher the incidence of THA; however, the Stulberg classification was not directly associated with the incidence of THA.

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Data Availability

Data are available in a repository upon request.

Code Availability

Not applicable.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Author notes

  1. Xinwang Zhi, Huimei Wu, and Chenyu Xiang contributed equally to this work.

  2. Hongwen Xu and Federico Canavese contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Orthopedics, GuangZhou Women and Children’s Medical Center, 9 Jinsui Road, Guangzhou, 510623, China

    Xinwang Zhi, Jianqun Wang, Hongwen Xu & Federico Canavese

  2. Academy of Orthopedics, Guangdong Province, Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, China

    Xinwang Zhi & Chun Zeng

  3. School of Pediatrics, Guangzhou Medical University, Xinzao, Guangzhou, 510000, China

    Huimei Wu & Chenyu Xiang

  4. Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Yeya Tan

  5. Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine, Jeanne de Flandre Hospital, Avenue Eugène-Avinée, 59000, Lille, France

    Federico Canavese

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Contributions

Xinwang Zhi: Data acquisition, analysis and interpretation of data drafting of the manuscript, final approval of the version to be published.

Huimei Wu: Data acquisition, analysis and interpretation of data drafting of the manuscript, final approval of the version to be published.

Chenyu Xiang: Data acquisition, analysis and interpretation of data drafting of the manuscript, final approval of the version to be published.

Jianqun Wang: Analysis and interpretation of data, drafting of the manuscript, final approval of the version to be published.

Yeya Tan: Analysis and interpretation of data, drafting of the manuscript, final approval of the version to be published.

Chun Zeng: Analysis and interpretation of data, critical review, final approval of the version to be published.

Hongwen Xu: Analysis and interpretation of data, critical review, final approval of the version to be published.

Federico Canavese: Study design, analysis and interpretation of data, drafting of the manuscript; editing and critical revision of the manuscript, final approval of the version to be published.

Corresponding authors

Correspondence to Hongwen Xu or Federico Canavese.

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Ethics approval

This is a meta-analysis, and no ethical approval was required to commence the study.

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Not applicable as this is a meta-analysis.

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All the authors are giving their consent to publish this paper.

The protocol of the meta-analysis was registered in the PRISMA International Prospective Register of Systematic Reviews (CRD42022352494).

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Fig. S1

Overall incidence of total hip arthroplasty in patients with >40 years of follow-up (I2=59%) (PNG 85 kb)

High resolution image (TIF 3152 kb)

Fig. S2

Sensitivity analysis of overall incidence of total hip arthroplasty in patients with >40 years of follow-up (PNG 66 kb)

High resolution image (TIF 2994 kb)

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Zhi, X., Wu, H., Xiang, C. et al. Incidence of total hip arthroplasty in patients with Legg-Calve-Perthes disease after conservative or surgical treatment: a meta-analysis. International Orthopaedics (SICOT) 47, 1449–1464 (2023). https://doi.org/10.1007/s00264-023-05770-5

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