The lateral pillar classification of Legg-Calvé-Perthes disease

To determine the predictive value of a new classification system for Legg-Perthes, 93 hips in 86 patients with radiographic follow-up to maturity were reviewed. All patients were treated by bracing at the Texas Scottish Rite Hospital from 1970 to 1980. Hips were classified during the fragmentation stage of disease into three groups based on radiolucency in the lateral pillar of the femoral head. Final radiographs were reviewed at skeletal maturity, and the outcome was determined according to the Stulberg classification. Group A had a uniformly good outcome (100% Stulberg I and II results); Group B had a good outcome in patients who were <9 years at onset (92% Stulberg I and II, 8% Stulberg III results), but a less favorable outcome in patients who were >9 years at onset (30% Stulberg II, 50% Stulberg III, and 20% Stulberg IV results). In Group C, the majority of femoral heads became aspherical in both age groups (29% Stulberg II, 52% Stulberg III, and 19% Stulberg IV results). The group C hips also had a longer duration of fragmentation and reossification stages. Members of the Legg-Perthes study group agreed 78% of the time when applying the classification to unknown radiographs. The classification group was a stronger determinant than age of onset in predicting final outcome. This classification system is easy to apply during the active stage of the disease and has a high correlation in predicting the amount of flattening of the femoral head at skeletal maturity. When combined with age at onset, it can be used to predict the natural history of the disease and evaluate various forms of treatment.