A prospective multicenter study of Legg-Calvé-Perthes disease: Functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years

A. Noelle Larson, Daniel J. Sucato, John Anthony Herring, Stephen E. Adolfsen, Derek M. Kelly, Jeffrey E. Martus, John F. Lovejoy, Richard Browne, Adriana DeLaRocha

Research output: Contribution to journalArticle

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Abstract

Background: Long-term studies have indicated good outcomes for most patients with Legg-Calvé-Perthes disease. However, clinical experience suggests that less favorable outcomes are common. We sought to prospectively document pain and function in a cohort of adults who had previously been treated nonoperatively for Legg-Calvé-Perthes disease. Methods: Patients in our region with Legg-Calvé-Perthes disease were enrolled between 1984 and 1991 as part of a multicenter prospective trial and were treated with hip range-of-motion exercises or bracing. Patients returned for physical examination, radiographs, and completion of outcome measures including the Nonarthritic Hip Score (NAHS) and the Iowa Hip Score (IHS). Results: Fifty-six patients (fifty-eight hips) were examined at a mean of 20.4 years (range, 16.3 to 24.5 years) after enrollment. The mean NAHS was 79 (range, 35 to 100), and the mean IHS was 74 (range, 43 to 100). Three patients had required hip arthroplasty and one patient had required a pelvic osteotomy. Fourteen (26%) of the remaining hips had no hip osteoarthritis, sixteen (30%) had mild osteoarthritis (Tönnis grade 1), and twenty-four (44%) had moderate or severe osteoarthritic changes on radiographs (grade 2 or 3). Femoroacetabular impingement indicated by physical examination was associated with pain and with poorer outcomes on the IHS and the NAHS (p = 0.0004, 0.0014, and 0.0007, respectively). The Stulberg classification was significantly associated with impingement on physical examination (p = 0.0495), the NAHS (p = 0.003), and the Tönnis grade (p = 0.012). Multivariate logistic regression showed that only the Stulberg classification was significantly associated with the NAHS (p = 0.0032); the odds ratio for a Stulberg type of I or II compared with IV or V in patients with a fair or poor NAHS was 0.101 (95% confidence interval, 0.018 to 0.573). Conclusions: Pain, arthritis, and ongoing hip dysfunction are common in patients with Legg-Calvé-Perthes disease that was treated nonoperatively. Hips rated as Stulberg type III or IV more frequently had poor or fair outcomes on the IHS and NAHS (61% and 72% for type III and 77% and 60% for type IV). Patients with a lateral pillar type of B, B/C, or C frequently had pain and radiographic evidence of osteoarthritis. Clinical signs of femoroacetabular impingement were associated with pain and with lower functional scores. This prospective study establishes a modern benchmark for outcomes following nonoperative, weight-bearing treatment of Legg-Calvé-Perthes disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)584-592
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume94
Issue number7
DOIs
StatePublished - Apr 4 2012

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Legg-Calve-Perthes Disease
Multicenter Studies
Hip
Prospective Studies
Pain
Femoracetabular Impingement
Physical Examination
Osteoarthritis
Benchmarking
Hip Osteoarthritis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

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A prospective multicenter study of Legg-Calvé-Perthes disease : Functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. / Larson, A. Noelle; Sucato, Daniel J.; Herring, John Anthony; Adolfsen, Stephen E.; Kelly, Derek M.; Martus, Jeffrey E.; Lovejoy, John F.; Browne, Richard; DeLaRocha, Adriana.

In: Journal of Bone and Joint Surgery - Series A, Vol. 94, No. 7, 04.04.2012, p. 584-592.

Research output: Contribution to journalArticle

Larson, A. Noelle ; Sucato, Daniel J. ; Herring, John Anthony ; Adolfsen, Stephen E. ; Kelly, Derek M. ; Martus, Jeffrey E. ; Lovejoy, John F. ; Browne, Richard ; DeLaRocha, Adriana. / A prospective multicenter study of Legg-Calvé-Perthes disease : Functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. In: Journal of Bone and Joint Surgery - Series A. 2012 ; Vol. 94, No. 7. pp. 584-592.
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title = "A prospective multicenter study of Legg-Calv{\'e}-Perthes disease: Functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years",
abstract = "Background: Long-term studies have indicated good outcomes for most patients with Legg-Calv{\'e}-Perthes disease. However, clinical experience suggests that less favorable outcomes are common. We sought to prospectively document pain and function in a cohort of adults who had previously been treated nonoperatively for Legg-Calv{\'e}-Perthes disease. Methods: Patients in our region with Legg-Calv{\'e}-Perthes disease were enrolled between 1984 and 1991 as part of a multicenter prospective trial and were treated with hip range-of-motion exercises or bracing. Patients returned for physical examination, radiographs, and completion of outcome measures including the Nonarthritic Hip Score (NAHS) and the Iowa Hip Score (IHS). Results: Fifty-six patients (fifty-eight hips) were examined at a mean of 20.4 years (range, 16.3 to 24.5 years) after enrollment. The mean NAHS was 79 (range, 35 to 100), and the mean IHS was 74 (range, 43 to 100). Three patients had required hip arthroplasty and one patient had required a pelvic osteotomy. Fourteen (26{\%}) of the remaining hips had no hip osteoarthritis, sixteen (30{\%}) had mild osteoarthritis (T{\"o}nnis grade 1), and twenty-four (44{\%}) had moderate or severe osteoarthritic changes on radiographs (grade 2 or 3). Femoroacetabular impingement indicated by physical examination was associated with pain and with poorer outcomes on the IHS and the NAHS (p = 0.0004, 0.0014, and 0.0007, respectively). The Stulberg classification was significantly associated with impingement on physical examination (p = 0.0495), the NAHS (p = 0.003), and the T{\"o}nnis grade (p = 0.012). Multivariate logistic regression showed that only the Stulberg classification was significantly associated with the NAHS (p = 0.0032); the odds ratio for a Stulberg type of I or II compared with IV or V in patients with a fair or poor NAHS was 0.101 (95{\%} confidence interval, 0.018 to 0.573). Conclusions: Pain, arthritis, and ongoing hip dysfunction are common in patients with Legg-Calv{\'e}-Perthes disease that was treated nonoperatively. Hips rated as Stulberg type III or IV more frequently had poor or fair outcomes on the IHS and NAHS (61{\%} and 72{\%} for type III and 77{\%} and 60{\%} for type IV). Patients with a lateral pillar type of B, B/C, or C frequently had pain and radiographic evidence of osteoarthritis. Clinical signs of femoroacetabular impingement were associated with pain and with lower functional scores. This prospective study establishes a modern benchmark for outcomes following nonoperative, weight-bearing treatment of Legg-Calv{\'e}-Perthes disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.",
author = "Larson, {A. Noelle} and Sucato, {Daniel J.} and Herring, {John Anthony} and Adolfsen, {Stephen E.} and Kelly, {Derek M.} and Martus, {Jeffrey E.} and Lovejoy, {John F.} and Richard Browne and Adriana DeLaRocha",
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language = "English (US)",
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T1 - A prospective multicenter study of Legg-Calvé-Perthes disease

T2 - Functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years

AU - Larson, A. Noelle

AU - Sucato, Daniel J.

AU - Herring, John Anthony

AU - Adolfsen, Stephen E.

AU - Kelly, Derek M.

AU - Martus, Jeffrey E.

AU - Lovejoy, John F.

AU - Browne, Richard

AU - DeLaRocha, Adriana

PY - 2012/4/4

Y1 - 2012/4/4

N2 - Background: Long-term studies have indicated good outcomes for most patients with Legg-Calvé-Perthes disease. However, clinical experience suggests that less favorable outcomes are common. We sought to prospectively document pain and function in a cohort of adults who had previously been treated nonoperatively for Legg-Calvé-Perthes disease. Methods: Patients in our region with Legg-Calvé-Perthes disease were enrolled between 1984 and 1991 as part of a multicenter prospective trial and were treated with hip range-of-motion exercises or bracing. Patients returned for physical examination, radiographs, and completion of outcome measures including the Nonarthritic Hip Score (NAHS) and the Iowa Hip Score (IHS). Results: Fifty-six patients (fifty-eight hips) were examined at a mean of 20.4 years (range, 16.3 to 24.5 years) after enrollment. The mean NAHS was 79 (range, 35 to 100), and the mean IHS was 74 (range, 43 to 100). Three patients had required hip arthroplasty and one patient had required a pelvic osteotomy. Fourteen (26%) of the remaining hips had no hip osteoarthritis, sixteen (30%) had mild osteoarthritis (Tönnis grade 1), and twenty-four (44%) had moderate or severe osteoarthritic changes on radiographs (grade 2 or 3). Femoroacetabular impingement indicated by physical examination was associated with pain and with poorer outcomes on the IHS and the NAHS (p = 0.0004, 0.0014, and 0.0007, respectively). The Stulberg classification was significantly associated with impingement on physical examination (p = 0.0495), the NAHS (p = 0.003), and the Tönnis grade (p = 0.012). Multivariate logistic regression showed that only the Stulberg classification was significantly associated with the NAHS (p = 0.0032); the odds ratio for a Stulberg type of I or II compared with IV or V in patients with a fair or poor NAHS was 0.101 (95% confidence interval, 0.018 to 0.573). Conclusions: Pain, arthritis, and ongoing hip dysfunction are common in patients with Legg-Calvé-Perthes disease that was treated nonoperatively. Hips rated as Stulberg type III or IV more frequently had poor or fair outcomes on the IHS and NAHS (61% and 72% for type III and 77% and 60% for type IV). Patients with a lateral pillar type of B, B/C, or C frequently had pain and radiographic evidence of osteoarthritis. Clinical signs of femoroacetabular impingement were associated with pain and with lower functional scores. This prospective study establishes a modern benchmark for outcomes following nonoperative, weight-bearing treatment of Legg-Calvé-Perthes disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Long-term studies have indicated good outcomes for most patients with Legg-Calvé-Perthes disease. However, clinical experience suggests that less favorable outcomes are common. We sought to prospectively document pain and function in a cohort of adults who had previously been treated nonoperatively for Legg-Calvé-Perthes disease. Methods: Patients in our region with Legg-Calvé-Perthes disease were enrolled between 1984 and 1991 as part of a multicenter prospective trial and were treated with hip range-of-motion exercises or bracing. Patients returned for physical examination, radiographs, and completion of outcome measures including the Nonarthritic Hip Score (NAHS) and the Iowa Hip Score (IHS). Results: Fifty-six patients (fifty-eight hips) were examined at a mean of 20.4 years (range, 16.3 to 24.5 years) after enrollment. The mean NAHS was 79 (range, 35 to 100), and the mean IHS was 74 (range, 43 to 100). Three patients had required hip arthroplasty and one patient had required a pelvic osteotomy. Fourteen (26%) of the remaining hips had no hip osteoarthritis, sixteen (30%) had mild osteoarthritis (Tönnis grade 1), and twenty-four (44%) had moderate or severe osteoarthritic changes on radiographs (grade 2 or 3). Femoroacetabular impingement indicated by physical examination was associated with pain and with poorer outcomes on the IHS and the NAHS (p = 0.0004, 0.0014, and 0.0007, respectively). The Stulberg classification was significantly associated with impingement on physical examination (p = 0.0495), the NAHS (p = 0.003), and the Tönnis grade (p = 0.012). Multivariate logistic regression showed that only the Stulberg classification was significantly associated with the NAHS (p = 0.0032); the odds ratio for a Stulberg type of I or II compared with IV or V in patients with a fair or poor NAHS was 0.101 (95% confidence interval, 0.018 to 0.573). Conclusions: Pain, arthritis, and ongoing hip dysfunction are common in patients with Legg-Calvé-Perthes disease that was treated nonoperatively. Hips rated as Stulberg type III or IV more frequently had poor or fair outcomes on the IHS and NAHS (61% and 72% for type III and 77% and 60% for type IV). Patients with a lateral pillar type of B, B/C, or C frequently had pain and radiographic evidence of osteoarthritis. Clinical signs of femoroacetabular impingement were associated with pain and with lower functional scores. This prospective study establishes a modern benchmark for outcomes following nonoperative, weight-bearing treatment of Legg-Calvé-Perthes disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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