Legg-Calve-Perthes’ disease.

Wall EJ. Curr Opin Pediatr 1999 Feb;11(1):76-9.

The etiology, radiographic classification, and treatment of Legg-Calve-Perthes’ disease remain controversial. Several recent papers focus on these issues in an effort to provide guidance in the clinical care of Perthes’ disease. The research studied in this paper lends further support to the hypothesis of clotting abnormalities with vascular thrombosis, which seems to be the most likely etiology for Legg-Calve-Perthes’ disease. Several studies focus on use of magnetic resonance imaging for the early diagnosis and prognosis of Perthes’ disease. A few researchers whose work is featured in this paper add information on the treatment of Perthes’ disease, supporting surgical treatment for older patients with more severe disease and non-surgical treatment for younger patients with less extensive femoral head involvement.

US of the painful hip in childhood: diagnostic value of cartilage thickening and muscle atrophy in the detection of Perthes disease.

Robben SG, Meradji M, Diepstraten AF, Hop WC. Radiology 1998 Jul;208(1):35-42

PURPOSE: To evaluate the combined use of several ultrasonographic (US) criteria in the detection of Perthes disease. MATERIALS AND METHODS: In a prospective study, 144 consecutive children with a painful hip underwent US. The thicknesses of the (a) anterior recess of the joint capsule, (b) cartilage of the femoral head, and (c) quadriceps muscle were assessed. Sixty-eight children with no symptoms, the control group, were also examined. RESULTS: The final diagnosis was transient synovitis (n = 58), Perthes disease (n = 21), slipped capital femoral epiphysis (SCFE; n = 5), or miscellaneous (n = 6). Fifty-four patients had no US or radiographic abnormalities, and symptoms disappeared during follow-up. The anterior recess in patients with transient synovitis was significantly wider than that in the other patients and control subjects (P < .001). Patients with Perthes disease showed significant cartilage thickening in the symptomatic hip compared with the other patients and control subjects (P < .001). Patients with Perthes disease and patients with SCFE showed significant atrophy of the ipsilateral quadriceps muscle compared with all other groups (P < .001). The combined use of these US criteria for the diagnosis of Perthes disease resulted in a positive predictive value of 95%, a negative predictive value of 95%, a sensitivity of 71%, and a specificity of 99%. CONCLUSION: The combination of several US criteria increases the diagnostic value of US of the painful hip in patients with Perthes disease.

Secondhand smoke, hypofibrinolysis, and Legg-Perthes disease.

Glueck CJ, Freiberg RA, Crawford A, Gruppo R, Roy D, Tracy T, Sieve-Smith L, Wang P. Clin Orthop 1998 Jul;(352):159-67

In 39 children with Legg-Perthes disease who were nonsmokers, the specific aim was to assess relationships among parental cigarette smoking during pregnancy, household smoking before diagnosis of Legg-Perthes disease, hypofibrinolysis, and thrombophilia. Fifteen (38%) children had no secondhand smoke exposure; 24 (62%) had secondhand smoke exposure before their diagnosis. Seventeen (71%) of these 24 children were exposed while in utero to smoking by a parent or live in relative and also had exposure to household smoke during childhood; seven (29%) had only household smoke exposure in childhood. In the full cohort of 39 children, secondhand smoke exposure correlated inversely with the major stimulator of fibrinolysis, stimulated tissue