A case of intra-articular snapping hip caused by articular cartilage detachment from the deformed femoral head consequent to perthes disease

2004 ◽  
Vol 20 (6) ◽  
pp. 650-653 ◽  
Author(s):  
Yasuhiro Yamamoto ◽  
Takatoshi Ide ◽  
Yoshiki Hamada ◽  
Ikuo Usui
Keyword(s):  
Articular Cartilage ◽  
Femoral Head ◽  
Perthes Disease ◽  
Snapping Hip

The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes’ disease

2021 ◽  
Vol 103-B (12) ◽  
pp. 1815-1820
Author(s):  
Stefan Huhnstock ◽  
Ola Wiig ◽  
Else Merckoll ◽  
Svein Svenningsen ◽  
Terje Terjesen
Keyword(s):  
Femoral Head ◽  
Skeletal Maturity ◽  
Strong Predictor ◽  
Perthes Disease ◽  
Radiological Outcome ◽  
Long Term Follow Up ◽  
The Mean ◽  
Stulberg Classification

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

Legg-Calvé-Perthes Disease

1986 ◽  
Vol 7 (10) ◽  
pp. 299-304
Author(s):  
William P. Bunnell
Keyword(s):  
Birth Weight ◽  
Femoral Head ◽  
Vascular Supply ◽  
Skeletal Age ◽  
Perthes Disease ◽  
Unknown Etiology ◽  
Necrotic Bone

Perthes disease is a condition of unknown etiology in which the vascular supply of the developing femoral head is temporarily interrupted, causing necrosis and collapse of the bony femoral head, followed by spontaneous revascularization and healing of the necrotic bone. It was independently described by four different authors (Legg, Calvé, Perthes, and Waldenstrom) in 1909 and 1910. They identified the condition as an affliction of the hip distinct from trauma and infection. The term "coxa plana" was applied to the characteristic flattening of the femoral head seen in Perthes disease. It was not until 10 years later that the actual pathology of avascular necrotic bone was described. EPIDEMIOLOGY The condition has its onset in children ranging in age from 2 to 12 years, with the majority of patients presenting between the ages of 4 and 8 years. Boys are affected four times more frequently than girls, and the condition is bilateral in approximately 15% of affected children. Certain constitutional factors are frequently found in children with Perthes disease. Skeletal age is delayed in nearly 90% of children affected with it. Affected boys have been found to be an average of 1 in shorter and affected girls 3 in shorter in height than their unaffected peers. Birth weight of affected children is frequently lower than average.

scholarly journals Algorithm for Early Diagnosis and Treatment Tactics of Diseases Accompanied by Coxalgia in Children

2009 ◽  
Vol 16 (2) ◽  
pp. 67-71
Author(s):  
Il'ya L'vovich Lobov ◽  
S E Kul'banskaya ◽  
M A Uronova ◽  
I L Lobov ◽  
S E Kulbanskaya ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Femoral Head ◽  
Early Diagnosis ◽  
Hip Joint ◽  
Blood Circulation ◽  
Perthes Disease ◽  
Diagnosis And Treatment ◽  
Joint Diseases

Examination and treatment of 524 children with coxalgia has been performed. Algorithm for early diagnosis of various hip joint diseases accompanied by coxalgia has been elaborated. The factors causing hip joint response resulting in different pathology including Leg-Calve-Perthes disease have been determined. In the majority of cases application of modified splint in combination with drug therapy enabled to normalize blood circulation in the affected joint and prevent the development of secondary deformities of the femoral head.

scholarly journals Extracorporeal Shockwave Therapy Modulates the Expressions of Proinflammatory Cytokines IL33 and IL17A, and Their Receptors ST2 and IL17RA, within the Articular Cartilage in Early Avascular Necrosis of the Femoral Head in a Rat Model

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Jai-Hong Cheng ◽  
Shun-Wun Jhan ◽  
Chieh-Cheng Hsu ◽  
Hung-Wen Chiu ◽  
Shan-Ling Hsu
Keyword(s):  
Articular Cartilage ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Volume Fraction ◽  
Bone Volume Fraction ◽  
Trabecular Thickness ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Trabecular Number

Avascular necrosis (AVN) of the femoral head (AVNFH) is a disease caused by injury to the blood supply of the femoral head, resulting in a collapse with osteonecrosis and damage to the articular cartilage. Extracorporeal shockwave therapy (ESWT) has been demonstrated to improve AVNFH owing to its anti-inflammation activity, angiogenesis effect, and tissue regeneration in clinical treatment. However, there are still so many pieces of the jigsaw that need to be fit into place in order to ascertain the mechanism of ESWT for the treatment of AVNFH. The study demonstrated that ESWT significantly protected the trabecular bone volume fraction BV/TV ( P < 0.01 ) and the trabecular thickness ( P < 0.001 ), while in contrast, the trabecular number and trabecular separation were not significantly different after treatment as compared with AVNFH. ESWT protected the articular cartilage in animal model of AVNFH. The levels of IL1-β and IL33 were significantly induced in the AVNFH group ( P < 0.001 ) as compared with Sham and ESWT groups and reduced in ESWT group ( P < 0.001 ) as compared with AVNFH group. In addition, the expression of the receptor of IL33, ST2, was reduced in AVNFH and induced after ESWT ( P < 0.001 ). The expression of IL17A was induced in the AVNFH group ( P < 0.001 ) and reduced in the ESWT group ( P < 0.001 ). Further, the expression of the receptor of IL17A, IL17RA, was reduced in the AVNFH group ( P < 0.001 ) and improved to a normal level in the ESWT group as compared with Sham group ( P < 0.001 ). Taken together, the results of the study indicated that ESWT modulated the expression of IL1-β, pro-inflammatory cytokines IL33 and IL17A, and their receptors ST2 and IL17RA, to protect against loss of the extracellular matrix in the articular cartilage of early AVNFH.

Relationship of peroxidation indicators and hemograms in children with hip joint pathology

2021 ◽  
Vol 66 (2) ◽  
pp. 104-109
Author(s):  
M. P. Teplen’kiy ◽  
E. L. Matveeva ◽  
E. S. Spirkina ◽  
A. G. Gasanova
Keyword(s):  
Lipid Peroxidation ◽  
Femoral Head ◽  
Hip Joint ◽  
Hip Dysplasia ◽  
Stage Ii ◽  
Perthes Disease ◽  
Antioxidant Protection ◽  
Aseptic Necrosis ◽  
Joint Pathology ◽  
Group I

The increase in the number of patients with hip pathologies among children of different ages makes the diagnosis and treatment of these diseases one of the most actually existing problems in modern orthopedics. The aim of the work was to determine the features of the lipid peroxidation system - antioxidant protection and hemogram indices in children with various forms of hip joint pathology. The results of a preoperative examination of 47 patients aged 6-15 years (average age 10.3 years) who were treated at the clinic “FSBI NICC“ TO ”named after academician G. A. Ilizarova, Ministry of Health of the Russian Federation. There were 25 boys and 20 girls. Given nosology, patients were divided into five groups. The diagnosis was established on the basis of a clinical and radiological examination. Group I consisted of 8 male patients with stage II Perthes disease (mean age 8.75 + 1.63). Group II includes 16 patients (8 boys, 7 girls) with stage III Perthes disease. (average age 11.80 + 0.89). Group III included 12 patients (6 boys, 6 girls) with aseptic necrosis of the femoral head (average age 14.7 + 2.35). Group IV consisted of 4 patients (1 boy, 3 girls) with epiphyseal dysplasia. (average age 10.25 + 1.36). Group V includes 7 patients with hip dysplasia complicated by aseptic necrosis of the femoral head (mean age 8.33 + 2.11). The norm is the data that was obtained after examining 10 healthy male adolescents (age 13-14) and 5 female adolescents (age 8-14 years). Changes in lipid peroxidation rates and antioxidant activity are unidirectional in different forms of pathology of the hip joints in children, and the content of peroxidation products reliably correlates with hemogram values in stage II osteochondropathy and complicated hip dysplasia. In the complex of diagnostic measures for children with dystrophic lesions of the hip joint, to clarify the nature and stage of the pathological process, as additional criteria, hemogram indicators and lipid peroxidation systems - antioxidant protection can be used.

Mutation of COL2A1 in a Chinese Family with Presentations of Legg-Calvé-Perthes Disease

2020 ◽  
Author(s):  
denglu yan ◽  
zhaojie Wang ◽  
Zhi Zhang
Keyword(s):  
Femoral Head ◽  
Sanger Sequencing ◽  
Structural Changes ◽  
Genetic Factors ◽  
Mutation Detection ◽  
Perthes Disease ◽  
Chinese Family ◽  
Col2a1 Gene ◽  
Whole Exome ◽  
Missense Substitution

Abstract Background: The aim of this study was to identify genetic factors and chromosomal regions contributing to osteonecrosis of the femoral head (ONFH) in a Chinese family with presentations of Legg-Calvé-Perthes Disease (LCDP). Methods: In this study, we performed whole exon sequencing of a Chinese family with LCPD for mutation detection. Ten members had ONFH in twenty-seven family members in four generations family, 5 unaffected members of the studied family and 5 normal peoples as control were underwent whole exome sequencing for mutation detection. Structural modeling test was applied to analyze the potential structural changes caused by the missense substitution. Results: In this Chinese family affected by LCPD, the mutation (c.3508 G>A, p. Gly1170Ser) in exon 50 of COL2A1 in the Gly–X–Y domain was present in 10 patients but absent in 5 unaffected members of the studied family and in 5 control chromosomes from unaffected individuals of matched geographical ancestry. The COL2A1 gene mutation was further validated by Sanger sequencing, confirmed that were heterozygous for the mutation. Then, we identified the p.Gly1170Ser mutation in exon 50 of COL2A1 in a Chinese family with LCPD. Conclusions: This study maps the mutation of mutation (c.3508 G>A, p. Gly1170Ser) in exon 50 of COL2A1 in the Gly–X–Y domain in a Chinese family of LCPD, which causes osteonecrosis of femoral head.

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