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

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 co...

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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
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spelling	my-usm-ep.606852024-07-17T08:13:52Z Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis 2022 Singh, Belzinder Pal R Medicine RC666-701 Diseases of the circulatory (Cardiovascular) system 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. 2022 Thesis http://eprints.usm.my/60685/ http://eprints.usm.my/60685/1/Belzinder%20Pal%20Singh-E.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	R Medicine RC666-701 Diseases of the circulatory (Cardiovascular) system
spellingShingle	R Medicine RC666-701 Diseases of the circulatory (Cardiovascular) system Singh, Belzinder Pal Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis
description	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.
format	Thesis
qualification_level	Master's degree
author	Singh, Belzinder Pal
author_facet	Singh, Belzinder Pal
author_sort	Singh, Belzinder Pal
title	Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis
title_short	Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis
title_full	Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis
title_fullStr	Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis
title_full_unstemmed	Outcome of different treatment modalities in severe Legg-Calve-Perthes Disease: a systematic review and meta-analysis
title_sort	outcome of different treatment modalities in severe legg-calve-perthes disease: a systematic review and meta-analysis
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2022
url	http://eprints.usm.my/60685/1/Belzinder%20Pal%20Singh-E.pdf
_version_	1804888985690963968

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

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