medigraphic.com
ISSN 2007-087X (Print)
Órgano Oficial de la Sociedad Mexicana de Ortopedia Pediátrica

2016, Number 2

<< Back Next >>

Rev Mex Ortop Ped 2016; 18 (2)

Radiographic and MRI findings associated with early degenerative joint disease of the hip in patients with Legg-Calvé-Perthes disease

Castańeda P, Serrano-Ardila AM, Vidal RC, Mijares J

Language: English
References: 23
Page: 83-88
PDF size: 171.41 Kb.


ABSTRACT

Objective: To identify a pattern of radiographic outcomes and Magnetic Resonance Imaging (MRI) findings in patients with the late sequelae of Legg-Calvé-Perthes disease (LCPD) leading to degenerative arthritis. Methods: 78 patients (88 hips) were classified into 3 groups according to the radiographic outcome at skeletal maturity: Group 1- Spherical congruency (n = 8), Group 2- Non-spherical congruency (n = 76) and Group 3- Incongruency (n = 4). MRI were obtained in 24 patients in Group 2, the presence of a labral injury was considered. We used the Tönnis scale to determine the presence of early degenerative arthritis at a minimum 10 year follow up. The Mann-Whitney U and Wilcoxon tests were used for statistical analysis. Results: Of the 8 hips in Group 1, 6 were considered Tönnis type 0 and 2 as type I (mean = 0.25). Of the 76 hips in Group 2, 4 were considered Tönnis type 0, 14 type I, 13 type II, 25 type III and 18 type IV (mean = 2.9). All 4 hips in Group 3 were considered Tönnis type IV. Of the 24 cases where an MRI was obtained in Group 2, 18 cases were found to have a labral tear, of these 18 hips, 6 were considered Tönnis type III and 12 as type IV. Univariate analysis demonstrated that joint incongruity and the presence of a labral tear were associated with signs of degenerative arthritis. Conclusion: The classification of hips in patients with LCPD into 3 Groups at skeletal maturity: 1. Spherical congruency, 2. Aspherical congruency and 3. Incongruency and the finding of a labral tear identifies patients at a higher risk of developing degenerative joint disease. Significance: The early radiographic and MRI patterns observed will allow surgeons to make better decisions in counselling their patients with LCPD.


REFERENCES

  1. Catterall A Legg-Calvé-Perthes disease. Edinburgh Churchill Livingstone, 1982.

  2. Gower WE, Johnston RC. Legg-Perthes disease. Long term follow-up of 36 patients. J Bone Joint Surg. 1971; 53(4): 759-768.

  3. McAndrew HP, Weinstein SL. A long term follow up of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1984; 66: 860-869.

  4. Ippolito E, Tudisco C, Farsetti P. Long-term prognosis of Legg-Calvé-Perthes disease developing during adolescence. J Pediatr Orthop. 1985; 5(6): 652-656.

  5. Smith-Petersen MN. Treatment of malum coxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty. J Bone Joint Surg. 1936; 18: 869-880.

  6. Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965; 38: 810-824.

  7. Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br. 1976; 58: 176-183.

  8. Solomon L, Beighton P. Osteoarthrosis of the hip and its relationship to pre-existing in an African population. J Bone Joint Surg Br. 1973; 55: 216-217.

  9. Solomon L, Schnitzler CM, Browett JP. Osteoarthritis of the hip: the patient behind the disease. Ann Rheum Dis. 1982; 41: 118-125.

  10. Harris WH. Primary osteoarthritis of the hip: a vanishing diagnosis. J Rheumatol. 1983; Suppl 9: 64.

  11. Harris WH, Bourne RB, Oh I. Intra-articular acetabular labrum: a possible etiological factor in certain cases of osteoarthritis of the hip. J Bone Joint Surg Am. 1979; 61: 510-514.

  12. Stulberg SD. Acetabular dysplasia, development of osteoarthritis of the hip. In: Harris WH, ed. The Hip: Proceedings of the Second Open Scientific Session of the Hip Society. St Louis, MO: CV Mosby; 1974: 82-93.

  13. Stulberg SD. Unrecognized childhood hip disease: a major cause of idiopathic osteoarthritis of the hip. In: Cordell LD, Harris WH, Ramsey PL, MacEwen GD, eds. The Hip: Proceedings of the Third Open Scientific Meeting of the Hip Society. St Louis, MO: CV Mosby; 1975:212–228.

  14. Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986; 213: 20-33.

  15. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003; 417: 112-120.

  16. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003; 417: 112-120.

  17. Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965; 38: 810-824.

  18. Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007; 15: 561-570.

  19. Catterall A. The natural history of Perthes disease. J Bone Joint Surg Br. 1971; 53: 37-53.

  20. Herring JA, Neustad JB, Williams JJ et al. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1992; 12: 143-150.

  21. Sankar WN, Thomas S, Castańeda P et al. Feasibility and safety of perfusion MRI for Legg-Calvé-Perthes disease. J Pediatr Orthop. 2014; 34: 679-682.

  22. Sebag G, Ducou Le Pointe H, Klein I, Maiza D, Mazda K, Bensahel H. Dynamic gadolinium-enhanced subtraction MR imaging: a simple technique for the early diagnosis of the Legg-Calvé-Perthes disease-preliminary results. Paed Radiol. 1997; 27(3): 216-220.

  23. Jaramillo D, Laor T. Pediatric musculoskeletal MRI: basic principles to optimize success. Pediatr Radiol. 2008; 38: 379-391.




2020     |     www.medigraphic.com