Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis

• Main Author: Singh, Belzinder Pal
• Format: Thesis
• Language: English
• Published: 2022
• Subjects: R Medicine; RC666-701 Diseases of the circulatory (Cardiovascular) system
• Online Access: http://eprints.usm.my/60685/1/Belzinder%20Pal%20Singh-E.pdf; http://eprints.usm.my/60685/
• Institution: Universiti Sains Malaysia

Introduction Legg–Calvé–Perthes disease (LCPD) is an idiopathic aseptic necrosis of the femoral head in children. Management of LCPD centres around containment of the femoral head within the acetabulum during the active phase of the disease. Multiple modalities are currently used to achieve said containment with varying results. We conducted a comprehensive systematic review and meta-analysis to estimate the overall pooled prevalence of Stulberg outcome in severe LCPD classified as Catterall III/IV and/or Herring lateral pillar classification B, B/C, C in children 6 years and older without hinge abduction after different treatment modalities. Materials and methods PubMed, Scopus, and Google Scholar databases were searched to identify studies published before 30th June 2021. We used random-effects model to estimate the pooled prevalence with 95% confidence intervals (CIs) of Stulberg outcome. Stulberg class I, II were defined as good outcome, Stulberg class III as fair outcome and Stulberg class IV, V were defined as poor outcome. Pooled Odds ratio (OR) with 95% confidence intervals (CIs) was calculated from studies comparing two different treatment modalities. As subgroups, pooled prevalence and 95% confidence intervals (CIs) of Stulberg outcome classifications in patients with severe LCPD after different treatment modalities was analysed. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. This study is registered with PROSPERO (CRD42021224676). Results We identified 1585 studies, of which 41 studies (1517 hips) were included in the meta-analysis. Overall, the pooled prevalence of good (Stulberg I, II), fair (Stulberg III) and bad (Stulberg IV, V) outcome in children 6 years or older with severe LCPD regardless of the treatment modality was 43.4% [95% CI: 38.3-48.4; I2 = 73%], 36.6% [95% CI: 32.5-40.7; I2 = 60%] and 15.9% [95% CI: 12.8-18.9; I2 = 60%] respectively. In terms of outcome after specific treatment modality, prevalence of good outcome was highest after Salter Innominate Osteotomy (SIO) at 54.4% [95% CI: 43.8-65.1; I2 = 68%]. Prevalence of bad outcome was highest after Arthrodiastasis 22.0% [95% CI: 12.4-31.5; I2 = 23%] and Non-operative 20.8% [95% CI: 12.5-29.2; I2 = 80%]. Studies comparing outcomes of Femoral Varus Osteotomy (FVO) versus non-operative showed a pooled Odds ratio (OR) for good outcome favouring FVO at 0.53 [95% CI: 0.35-0.81; p = 0.003; I2 = 0%] and pooled OR for bad outcome was higher in non-operative at 3.05 [95% CI: 1.71-5.42: p = 0.0002; I2 = 0%]. Conclusion In children 6 years and older diagnosed with severe LCPD without hinge abduction, all operative treatment modalities except for arthrodiastasis had better outcome compared to non-operative treatment. Salter Innominate Osteotomy (SIO) had the highest prevalence of good outcome results in severe LCPD hips as well as in the subgroup of Herring C & Catterall IV hips.