Stulberg Classification System for Evaluation of Legg-Calvé-Perthes Disease

1999 ◽  
Vol 81 (9) ◽  
pp. 1209-16 ◽  
Author(s):  
JEROEN G. NEYT ◽  
STUART L. WEINSTEIN ◽  
KEVIN F. SPRATT ◽  
LORI DOLAN ◽  
JOSÉ MORCUENDE ◽  
...  
Keyword(s):  
Classification System ◽  
Perthes Disease ◽  
Stulberg Classification

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.

Advanced containment methods for Legg-Calvé-Perthes disease: triple pelvic osteotomy versus Chiari osteotomy

2017 ◽  
Vol 28 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Olivier Rosello ◽  
Federico Solla ◽  
Ioana Oborocianu ◽  
Edouard Chau ◽  
Tony ElHayek ◽  
...  
Keyword(s):  
Pelvic Osteotomy ◽  
Wilcoxon Test ◽  
Perthes Disease ◽  
Harris Hip Score ◽  
Salter Osteotomy ◽  
Stulberg Classification ◽  
And Performance ◽  
And Function ◽  
Chiari Osteotomy

Introduction: The goal of intervention in Legg-Calvé-Perthes disease (LCPD) is to prevent femoral head deformation by containing the head within the acetabulum. Currently, surgical containment methods are the mainstay of treatment, and pelvic osteotomies have been shown to be successful. They include triple pelvic osteotomy (TPO), Salter osteotomy, Chiari osteotomy and shelf procedure. The purpose of this study was to compare clinical and radiologic results for Chiari osteotomy and TPO in LCPD. Methods: 29 children treated between 1980 and 2010 for LCPD in 2 centres were reviewed. 19 underwent TPO, and 10, Chiari osteotomy. Two independent observers assessed sequential radiographs and medical data. Each hip was preoperatively classed by clinical data, Catteral, Herring and Salter-Thompson classification, centre-edge angle (CE), and acetabular index (AI). The 2 groups were first tested for their comparability. After surgery the hips were classified by Stulberg classification, CE, AI, Harris Hip Score (HHS) and performance of further surgery. Chiari osteotomy and TPO have been secondary compared on these data by Wilcoxon test. Results: Average follow-up was 4.2 years. The 2 groups were comparable before surgery. At first and last follow-up examination, statistically significantly superior results in patients with TPO regarding Stulberg classification (p = 0.01), AI (p = 0.002), pain (p = 0.02) and function (p = 0.01) in the HHS score were found. No differences were noticed concerning CE angle. Conclusions: In our series, TPO provided better radiologic and clinical outcomes compared to Chiari osteotomy, specially concerning the final Stulberg classification. We concluded that TPO should be preferred when indicated.

Stulberg Classification System

2000 ◽  
Vol 82 (10) ◽  
pp. 1517 ◽  
Author(s):  
Stuart L. Weinstein ◽  
Lori A. Dolan ◽  
Kevin F. Spratt
Keyword(s):  
Classification System ◽  
Stulberg Classification

Outcome after osteochondroplasty and relative neck lengthening for patients with healed Legg-Calvé-Perthes disease: a retrospective cohort study of patients with hip-deformities treated with osteochondroplasty and relative neck lengthening

2019 ◽  
pp. 112070001989676 ◽  
Author(s):  
Olof Risto ◽  
Sofia Sandquist ◽  
Stefan Lind ◽  
Sanjeev Madan
Keyword(s):  
Retrospective Cohort ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Age At Onset ◽  
Hip Dislocation ◽  
Cross Sectional Study ◽  
Perthes Disease ◽  
Harris Hip Score ◽  
Cross Sectional ◽  
Stulberg Classification

Aims: Our main objectives were to evaluate the effect of surgery using self-assessed health scores. Secondary objectives were to correlate outcome with grade of deformity (Stulberg classification I–V) or age at surgery and whether additional periacetabular osteotomy (PAO) is beneficial for patients with concurrent acetabular dysplasia. Methods: This was a retrospective cohort and in part a cross sectional study using a planned clinical and radiological follow-up of patients. All patients with healed Legg-Calvé-Perthes disease (LCPD) treated with osteochondroplasty and relative neck lengthening using surgical hip dislocation, with or without periacetabular osteotomy (PAO) were included. A total of 39 patients were identified and invited to participate (29 males and 10 females) of which 32 accepted. Radiographic assessment and Stulberg classification were obtained. The Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS) and the VAS scale of EQ-5D-5L were used. Results: The majority of the patients experienced improvement (74%, n = 27) and 21 patients (78%, n = 27) found the surgery worthwhile. Preoperative Stulberg II and III patients (83% improvement) showed better results than Stulberg IV and V patients (56% improvement) ( n = 27, p = 0.121). There was significantly better patient-satisfaction for those younger than 29 years of age (⩽18 years old (92%), 19–28 years old (89%), ⩾29 years old (67%), x2(2) = 8512, n = 27, p = 0.022) and a negative correlation for age at onset of LCPD and mHHS ( r = –0.420, p = 0.046, n = 23). Patients with concurrent acetabular dysplasia ( n = 19), 82% (9 of 11) improved after additional PAO compared to 63% (5 of 8) who were not operated on with PAO. Conclusion: This procedure is worthwhile in selected cases except for severe deformity (Stulberg IV and V) and patients >28 years of age.

Interobserver and Intraobserver Reliability of the Modified Waldenström Classification System for Staging of Legg-Calvé-Perthes Disease

2015 ◽  
Vol 97 (8) ◽  
pp. 643-650 ◽  
Author(s):  
Joshua E Hyman ◽  
Evan P Trupia ◽  
Margaret L Wright ◽  
Hiroko Matsumoto ◽  
Chan-Hee Jo ◽  
...  
Keyword(s):  
Classification System ◽  
Intraobserver Reliability ◽  
Perthes Disease

scholarly journals REPRODUCIBILITY OF MODIFIED WALDENSTRÖM CLASSIFICATION IN PERTHES DISEASE

2021 ◽  
Vol 29 (2) ◽  
pp. 92-96
Author(s):  
FELIPPI GUIZARDI CORDEIRO ◽  
PATRICIA MORENO GRANGEIRO ◽  
BRUNO SÉRGIO FERREIRA MASSA ◽  
NEI BOTTER MONTENEGRO ◽  
ROBERTO GUARNIERO
Keyword(s):  
Classification System ◽  
Reasonable Agreement ◽  
Interobserver Agreement ◽  
Interobserver Reliability ◽  
Perthes Disease ◽  
Intraobserver Agreement ◽  
Level Of Evidence ◽  
Resident Physicians ◽  
Kappa Value ◽  
Kendall’S W

ABSTRACT Objective: The purpose of our study is to evaluate intraobserver and interobserver reliability of modified Waldenström classification system for Legg-Calvé-Perthes disease and assess the influence of the professional’s area of expertise in the assessment. Methods: Twelve evaluators assessed 40 pairs of pelvic radiographs of patients with Legg-Calvé-Perthes disease. After two weeks, a new evaluation was performed by the same evaluators. Kappa and Kendall’s W indexes were used to evaluate both intraobserver and interobserver reliability and determine the influence of the evaluators’ experience and area of expertise. Results: The average intraobserver kappa value was 0.394, with a reasonable agreement level. The interobserver Kappa value was 0.243 in the first evaluation (95% CI, 0.227-0.259 and p < 0.0001) and 0.245 in the second evaluation (95% CI, 0.229-0.260 and p < 0.0001). The Kendall’s W values obtained for pediatric orthopedists, radiologists and resident physicians were 0.686, 0.630 and 0.529 (p < 0.0001), respectively. Conclusion: The modified Waldenström classification presented both moderate and reasonable levels of intraobserver agreement, and reasonable level of interobserver agreement. The evaluators’ degree of experience and area of expertise influenced the concordance level found. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Test.

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