Legg-calve-perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome

Abstract

Background The treatments for Legg-Calve-Perthes disease (LCPD) are controversial and lack evidence. They vary from long term non-weight bearing, abduction cast treatment, combined femoral and pelvic surgical procedures and ignoring the disease altogether (supervised neglect). The authors recruited 39 surgeons from 28 centres in the USA to take part in this prospective study in order to provide an informed decision about LCPD treatment. Methods This was a prospective cohort study of 438 patients (451 affected hips). Each of the 39 surgeons applied the same treatment method to each of his or her patients. The fi ve treatment groups were compared: (1) no treatment, (2) brace treatment, (3) range-of-motion exercises, (4) femoral osteotomy, and (5) innominate osteotomy. Age range was 6-12 years and none had received prior treatment. All hips were classifi ed with the modifi ed lateral pillar and Stulberg classifi cations. A multinomial logistic regression analysis was used to determine which combination of factors affected the probability of a particular outcome: Stulberg class I or II, Stulberg class III, and Stulberg class IV or V. Results Three hundred and forty-fi ve hips in 337 patients were available for follow-up at skeletal maturity. Treatment did not have a signifi cant effect on children who had a chronologic age of 8 years or less or a skeletal age of 6 years or less at the onset of the disease. In the lateral pillar B group and B/C border group, the outcomes of surgical treatment were signifi cantly better than those of non-operative treatment in children >8 years at the onset of the disease (p = 0.05). Patients who were 8 years old or less at the onset of the disease in lateral pillar group B did equally well with non-operative and operative treatment. Hips in lateral pillar group C had the least favorable outcomes, with no differences between the operative and non-operative groups. Table 146.1 summarise the fi ndings. Conclusions Surgical intervention (femoral osteotomy or innominate osteotomy) improved outcomes in patients with LCPD when they are 8 years or older at the time of onset and have a hip in the lateral pillar B group or B/C border group. Other patients did not benefi t from surgery.