Abstract
Legg-Calve-Perthes disease (LCPD) is an idiopathic hip disorder that causes ischemic necrosis of the growing femoral head. It is a known cause of femoroacetabular impingement (FAI) in older children and adolescents because of the development of a misshapen head and corresponding acetabular deformity. Moreover, hip instability, extra-articular impingement, hinge abduction, and versional deformities are found in Perthes hips. These all have the potential to lead to debilitating arthritis later in life. Although hip arthroscopy has proven to be successful in the treatment of FAI, its role and indications in LCPD-associated FAI remain unclear. Historically, the most common indication for hip arthroscopy in the pediatric and adolescent population has been in LCPD, for both the diagnosis of the severity of the disease and the removal of loose bodies. With improved techniques and instrumentation, however, the indications have expanded to include femoral head/neck reshaping, labral repair, and acetabular trimming in mild residual LCPD, while open treatment options allow more comprehensive deformity correction in moderate to severe cases of residual deformity. Short-term outcome studies have been promising; however, longer-term studies are needed to see if the natural long-term history of LCPD can be affected.
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References
Stulberg SD, Cooperman DR, Wallensten R. The natural history of legg-calve-perthes disease. J Bone Joint Surg Am. 1981;63(7):1095–108.
Weinstein SL. Legg-calve-perthes disease: results of long-term follow-up. Hip. 1985;1:28–37.
Legg AT. An obscure affection of the hip joint. 1910. Clin Orthop Relat Res. 2006;451:11–3.
Miyamoto Y, Matsuda T, Kitoh H, Haga N, Ohashi H, Nishimura G, et al. A recurrent mutation in type II collagen gene causes legg-calve-perthes disease in a Japanese family. Hum Genet. 2007;121(5):625–9.
Glueck CJ, Glueck HI, Greenfield D, Freiberg R, Kahn A, Hamer T, et al. Protein C and S deficiency, thrombophilia, and hypofibrinolysis: pathophysiologic causes of legg-perthes disease. Pediatr Res. 1994;35(4 Pt 1):383–8.
Hresko MT, McDougall PA, Gorlin JB, Vamvakas EC, Kasser JR, Neufeld EJ. Prospective reevaluation of the association between thrombotic diathesis and legg-perthes disease. J Bone Joint Surg Am. 2002;84(9):1613–8.
Molloy MK, MacMahon B. Incidence of legg-perthes disease (osteochondritis deformans). N Engl J Med. 1966;275(18):988–90.
Kim HK. Legg-calve-perthes disease. J Am Acad Orthop Surg. 2010;18(11):676–86.
Waldenstrom H. The definite form of the coxa Plana. Acta Radiol. 2016;57(7):e79–94.
Eijer H, Berg RP, Haverkamp D, Pecasse GA. Hip deformity in symptomatic adult perthes’ disease. Acta Orthop Belg. 2006;72(6):683–92.
Eijer H, Podeszwa DA, Ganz R, Leunig M. Evaluation and treatment of young adults with femoro-acetabular impingement secondary to perthes’ disease. Hip Int. 2006;16(4):273–80.
Catterall A. Natural history, classification, and x-ray signs in legg-calve-perthes’ disease. Acta Orthop Belg. 1980;46(4):346–51.
Herring JA, Kim HT, Browne R. Legg-calve-perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and stulberg classifications. J Bone Joint Surg Am. 2004;86(10):2103–20.
Mose K, Hjorth L, Ulfeldt M, Christensen ER, Jensen A. Legg calve perthes disease. The late occurrence of coxarthrosis. Acta Orthop Scand Suppl. 1977;169:1–39.
Catterall A. The natural history of perthes’ disease. J Bone Joint Surg. 1971;53(1):37–53.
Grossbard GD. Hip pain during adolescence after perthes’ disease. J Bone Joint Surg. 1981;63B(4):572–4.
Catterall A. Adolescent hip pain after perthes’ disease. Clin Orthop Relat Res. 1986;209:65–9.
Snow SW, Keret D, Scarangella S, Bowen JR. Anterior impingement of the femoral head: a late phenomenon of legg-calve-perthes’ disease. J Pediatr Orthop. 1993;13(3):286–9.
Sucato DJ. Role of femoral head surgery in skeletally mature perthes disease. J Pediatr Orthop. 2013;33(Suppl 1):S70–5.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.
Kim YJ, Novais EN. Diagnosis and treatment of femoroacetabular impingement in legg-calve-perthes disease. J Pediatr Orthop. 2011;31(2 Suppl):S235–40.
Novais EN, Clohisy J, Siebenrock K, Podeszwa D, Sucato D, Kim YJ. Treatment of the symptomatic healed perthes hip. Orthop Clin North Am. 2011;42(3):401–17, viii
Roy DR. Arthroscopic findings of the hip in new onset hip pain in adolescents with previous legg-calve-perthes disease. J Pediatr Orthop B. 2005;14(3):151–5.
Tiwari V, Gamanagatti S, Mittal R, Nag H, Khan SA. Correlation between MRI and hip arthroscopy in children with legg-calve-perthes disease. Musculoskelet Surg. 2018;102(2):153–7.
Upadhyay SS, Burwell RG, Moulton A. Femoral anteversion in perthes’ disease with observations on irritable hips. Application of a new method using ultrasound. Clin Orthop Relat Res. 1986;209:70–6.
Lerch TD, Todorski IAS, Steppacher SD, Schmaranzer F, Werlen SF, Siebenrock KA, et al. Prevalence of femoral and acetabular version abnormalities in patients with symptomatic hip disease: a controlled study of 538 hips. Am J Sports Med. 2018;46(1):122–34.
Ezoe M, Naito M, Inoue T. The prevalence of acetabular retroversion among various disorders of the hip. J Bone Joint Surg Am. 2006;88(2):372–9.
Kawahara S, Nakashima Y, Oketani H, Wada A, Fujii M, Yamamoto T, et al. High prevalence of acetabular retroversion in both affected and unaffected hips after Legg-calve-perthes disease. J Orthop Sci. 2012;17(3):226–32.
Sankar WN, Flynn JM. The development of acetabular retroversion in children with legg-calve-perthes disease. J Pediatr Orthop. 2008;28(4):440–3.
Kim HT, Wenger DR. “Functional retroversion” of the femoral head in legg-calve-perthes disease and epiphyseal dysplasia: analysis of head-neck deformity and its effect on limb position using three-dimensional computed tomography. J Pediatr Orthop. 1997;17(2):240–6.
Gutierrez R, Iban M, Ayestaran A, Sobrino A, Oteo-Alvaro A. Peripheral compartment as the initial access for hip arthroscopy in complex cases: technical note. Orthopedics. 2013;36(6):456–62.
Stalzer S, Wahoff M, Scanlan M. Rehabilitation following hip arthroscopy. Clin Sports Med. 2006;25(2):337–57, x
McAndrew MP, Weinstein SL. A long-term follow-up of legg-calve-perthes disease. J Bone Joint Surg Am. 1984;66(6):860–9.
Larson AN, Sucato DJ, Herring JA, Adolfsen SE, Kelly DM, Martus JE, et al. A prospective multicenter study of legg-calve-perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Joint Surg Am. 2012;94(7):584–92.
Garceau G. Surgical treatment of coxa plana. J Bone Joint Surg. 1964;46B:779.
Rowe SM, Jung ST, Cheon SY, Choi J, Kang KD, Kim KH. Outcome of cheilectomy in legg-calve-perthes disease: minimum 25-year follow-up of five patients. J Pediatr Orthop. 2006;26(2):204–10.
Kocher MS, Kim YJ, Millis MB, Mandiga R, Siparsky P, Micheli LJ, et al. Hip arthroscopy in children and adolescents. J Pediatr Orthop. 2005;25(5):680–6.
Bowen JR, Kumar VP, Joyce JJ 3rd, Bowen JC. Osteochondritis dissecans following perthes’ disease. Arthroscopic-operative treatment. Clin Orthop Relat Res. 1986;209:49–56.
O’Leary JA, Berend K, Vail TP. The relationship between diagnosis and outcome in arthroscopy of the hip. Arthroscopy. 2001;17(2):181–8.
Lamplot JD, Schoeneck PL, Pascual-Garrido C, Nepple JJ, Clohsy JC. Open reduction and internal fixation for the treatment of symptomatic osteochondritis dissecans of the femoral head in patients with sequelae of legg-calve-perthes disease. J Pediatr Orthop. 2020;40(3):120–8.
Freeman CR, Jones K, Byrd JW. Hip arthroscopy for legg-calve-perthes disease: minimum 2-year follow-up. Arthroscopy. 2013;29(4):666–74.
Kanatli U, Ayanoglu T, Ozer M, Ataoglu MB, Cetinkaya M. Hip arthroscopy for legg-calve-perthes disease in paediatric population. Acta Orthop Traumatol Turc. 2019;53(3):203–8.
Lee WY, Hwang DS, Ha YC, Kim PS, Zheng L. Outcomes in patients with late sequelae (healed stage) of legg-calve-perthes disease undergoing arthroscopic treatment: retrospective case series. Hip Int. 2018;28(3):302–8.
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Riley, P., Kocher, M.S., Hussain, Z.B., Yen, YM. (2022). Surgical Technique: Arthroscopic Treatment of Perthes Disease. In: Nho, S.J., Bedi, A., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-43240-9_35
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DOI: https://doi.org/10.1007/978-3-030-43240-9_35
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