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Legg-Calvé-Perthes Disease at 100: A Review of Evidence-based Treatment

Herring, John Anthony MD*,†

Journal of Pediatric Orthopaedics: September 2011 - Volume 31 - Issue - p S137–S140
doi: 10.1097/BPO.0b013e318223b52d
Introduction

Background: The year 2010 is the 100th anniversary of the publication of the first 3 reports describing Legg- Calve-Perthes disease (LCPD). This paper summarizes available evidence previously published and discussed at the several world conferences honoring the occasion.

Methods: Relevant articles with evidence-based data regarding the efficacy of treatment methods for LCPD were reviewed by the author.

Results: The reviewed studies noted 3 factors related to outcome in patients treated for LCPD as follows: the age at onset, the classification of severity of femoral head involvement, and the type of treatment. In patients over age 8 at onset, surgical treatment with femoral varus osteotomy or Salter innominate osteotomy was associated with improved Stulberg outcomes compared with nonoperative treatment, in those who had lateral pillar B or B/C border class involvement. In the Wiig et al study, patients over age 6 with Catterall 3, 4 classification had better outcomes with these surgical treatment methods compared with nonoperative methods. Children under age 6 at onset had a good prognosis except for a small number of patients between age 4 and 6 years with lateral pillar C involvement.

Conclusions: There is valid evidence of an association between surgical treatment of certain patients with LCPD and improved radiographic outcome.

Level of evidence: Level II.

*Texas Scottish Rite Hospital for Children

Orthopaedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX

John Anthony Herring, MD, has received royalties from Medtronic and Elsevier for textbook royalties.

Reprint: John Anthony Herring, MD, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. Email: tony.herring@tsrh.org.

© 2011 Lippincott Williams & Wilkins, Inc.