Publication: Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis
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Date
2022
Authors
Singh, Belzinder Pal
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Abstract
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.