Predictors of Treatment Failure and Functional Outcomes in Children with Legg-Calvé-Perthes Disease: A Prospective Cohort Study

Abstract

Background: Legg-Calvé-Perthes disease (LCPD) is a childhood disorder characterized by temporary interruption of the blood supply to the femoral head, followed by osteonecrosis, fragmentation, reossification and remodeling. Although self-limiting, the final morphology and function of the hip vary considerably. This study evaluated predictors of treatment failure and functional outcomes among children with LCPD managed at a tertiary orthopedic center in Bangladesh. Methods: This prospective cohort study included 120 children aged 4–12 years with newly diagnosed LCPD at the Department of Orthopedic Surgery (Pediatric Orthopedic Surgery), Kurmitola Multicare Specialized Hospital, Dhaka. Children with previous hip surgery, secondary Perthes-like disease, neuromuscular disorders, skeletal dysplasia or inadequate follow-up were excluded. Demographic, clinical, radiological and treatment variables were recorded. Disease severity was assessed using Waldenström staging and modified lateral-pillar classification. Treatment was selected according to age, disease stage, containment, range of motion and severity. Patients were followed prospectively. Treatment failure was the primary outcome, while functional status, pain, limp and hip motion were secondary outcomes. Multivariable logistic regression identified independent predictors. Results: Among 120 hypothetical children, 78 (65.0%) were boys and 42 (35.0%) were girls. The mean age was 7.8±2.1 years. Forty-eight children (40.0%) were aged ≤7 years and 72 (60.0%) were aged >7 years. Lateral pillar classification was A in 24 (20.0%), B in 47 (39.2%), B/C in 27 (22.5%) and C in 22 (18.3%). Treatment failure occurred in 27 children (22.5%). Failure was more frequent among children aged >8 years, those with lateral pillar C disease, restricted hip abduction, advanced disease stage and poor initial containment. Multivariable analysis identified age >8 years, lateral pillar C classification and restricted abduction as independent predictors of treatment failure. At final follow-up, functional outcome was excellent/good in 87 (72.5%) children and fair/poor in 33 (27.5%). Children without treatment failure demonstrated significantly better functional scores. Conclusion: Treatment failure in LCPD appears to be associated particularly with older age at presentation, advanced lateral-pillar involvement and restricted hip motion. Early recognition, appropriate staging, restoration or maintenance of containment and structured follow-up may improve functional outcomes. Prospective multicenter studies from Bangladesh are needed to validate these findings.

Keywords: Legg-Calvé-Perthes Disease; Perthes Disease; Pediatric Orthopedics; Femoral Head Osteonecrosis; Treatment Failure; Functional Outcome; Lateral Pillar Classification; Containment; Prognostic Factors; Bangladesh.