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Operative Versus Nonoperative Treatments for Legg-Calvé-Perthes Disease: A Meta-Analysis

Nguyen, Nhu-An T. BS*; Klein, Guy DO; Dogbey, Godwin PhD*; McCourt, Jessica B. PA-C; Mehlman, Charles T. DO, MPH

doi: 10.1097/BPO.0b013e318269c55d

Background: Legg-Calvé-Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head primarily affecting children of ages 4 to 12 years. There is no clear consensus on nonoperative or operative treatment protocols for pediatric patients presenting with LCPD. This study uses meta-analysis and a binary logistic regression model to analyze the radiographic outcomes of these treatment modalities in pediatric patients.

Methods: Clinical studies describing patients undergoing either nonoperative or operative treatment of LCPD published from 1960 through 2010 were searched electronically and manually. Eligible studies consisted of (1) a minimum of 10 patients; (2) listed age at the time of diagnosis or treatment; (3) performed an initial severity assessment using the Herring or Catterall classification; (4) detailed the type of intervention; and (5) reassessment of radiographic outcome after a minimum of 1 year after treatment using the Mose or Stulberg classification.

Results: Twenty-three studies, 1232 patients, and 1266 hips met the inclusion criteria. Among patients younger than 6 years, operative and nonoperative treatments are equally as likely to results in a successful radiographic outcome [odds ratio (OR)=1.071; P=0.828; 95% confidence interval (CI), 7.377-32.937]. In patients older than 6 years, operative treatment is nearly twice as likely to result in a successful radiographic outcome (OR=1.754; P<0.0001; 95% CI, 1.299-2.370). For age at treatment less than 6 years, a patient treated with a pelvic rather than femoral procedure was approximately 5 times as likely to have a good radiographic outcome (χ2=4.488; P=0.034; unadjusted OR=5.20; 95% CI, 1.021-26.471). Among patients ages 6 or older, pelvic procedures were equally as likely as femoral procedures to yield a successful radiographic outcome (χ2=1.845; P=0.174; unadjusted OR=1.329; 95% CI, 0.881-2.004). Sex had no significant influence on radiographic outcome (OR=1.248; P=0.486; 95% CI, 0.670-2.325).

Conclusions: This meta-analysis suggests that operative treatment is more likely to yield a spherical congruent femoral head than nonoperative methods among patients 6 years or older. Among patients younger than 6 years, operative and nonoperative methods have the same likelihood to yield a good outcome. Patients who were 6 years or older were treated operatively, and had the same likelihood of a good radiographic outcome regardless of treatment with femoral or pelvic procedures. Among patients younger than 6 years, pelvic procedures were more likely to result in a good radiographic outcome than femoral procedures.

Level of Evidence: Level IV meta-analysis.

*Ohio University College of Osteopathic Medicine, Athens

Orthopaedic Surgery Residency Program, University Hospitals, Richmond Heights

Department of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Supported in part by the University of Cincinnati Orthopaedic Research and Education Fund and Division of Pediatric Orthopaedic Surgery at Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

The authors declare no conflict of interest.

Reprints: Charles T. Mehlman, DO, MPH, Department of Pediatric Orthopaedic Surgery, 45229 Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 2017, 45229 Cincinnati, OH. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.