Result of an inquiry to the families with Legg-Calvé-Perthes  disease patients in the R.U. and Ireland.  The importance of the information and the opinion of the patient and its family, in the analysis of the disease. 

 

Nuno Craveiro Lopes M..D., Orthopaedic Department, Garcia de Orta Hospital, Almada, Portugal

Sheila Trever, Parents of Perthes Support Group, Hull, United Kingdom

 

 

ABSTRACT

The study of of Legg-Calvé-Perthes disease (LCPD) has come to be made almost exclusively on the basis of experimental, clinical and image data, not being generally valued the opinion of the patient and its families on the possible causes, evolution and final result of the disease. 

 

With the contribution of the Parents of Perthes Support Group, questionnaires have been sent to 150 families of the United Kingdom and Ireland, in order to compile data about 3 stages of the disease: 

1) Factors passible to be in the genesis of the disease. 

2) Data about the diagnosis and treatment of the disease. 

3) Data about the final functional result. 

76 questionnaires have been received, concerning 91 episodes of LCPD, which have been subjected to statistical analysis. 

A ratio of 4,5/1 was found for the male/female relation and the age of beginning varied between 2 and 12 years of age. 

From the whole cases, 15 were bilateral (20%) and others 27 cases (35%) presented painful symptoms before or during the evolution of the contralateral illness. 

The characteristics most significant of this group of children, included hyperactivity (84,6%), predominant sleeping position in ventral decubitus (47,2%) and low stature (27,5%).

The percentage of patients who related intermittent painful complaints before the diagnosis was very high: 53 (70%), varying its antecedence between 2 months and 4 years.  Of these 53 patients, 40 (75%) had related multiples painful episodes, before the declaration of the disease.

It was not found statistically significant relation in between the occorence of the disease and the eventual ambient pollution or tobacco smoke, with hereditary factors, with the existence of blood, hormonal or metabolic problems. 

The analysis of the final results with an average of follow-up of 6 years (the 2 52 years), did not shown to exist statistically significant differences between sex, age groups, degree of activity and between conservative and surgical treatment (femoral osteotomy). 

The result of this work, confirm some known data, as the existence of low stature and hiperactividade in these children.

It reveals some new data, namely the existence of a predominant sleeping position in ventral decubitus on those patients and of repeated episodes of painful complaints on the affected hip before the appearance of the disease, facts that point to the existence of a premonitory situation that can allow a precocious detections and the introduction of preventive measures. 

It comes finally, to put in doubts some data, namely, the influence of tobacco smoke, the existence of blood, hormonal or metabolic problems in the genesis of the disease, the worse prognostic in the female and in the older child, and the better results with surgical treatment.