RADIOGRAPHIC STUDY OF THE MEDIAL JOINT SPACE OF THE HIP IN LEGG-CALVÉ-PERTHES DISEASE

DUJARDIN, RENE; MIRAS, DIEGO PRAXEDES DE; GIANNOTTI, CAIO FALK; NICOLAU, ROBERTO BEZERRA; DOBASHI, EIFFEL TSUYOSHI

doi:10.1590/1413-785220223006e256112

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ORIGINAL ARTICLE, PEDIATRIC ORTHOPEDICS • Acta ortop. bras. 30 (6) • 2022 • https://doi.org/10.1590/1413-785220223006e256112 linkcopy

RADIOGRAPHIC STUDY OF THE MEDIAL JOINT SPACE OF THE HIP IN LEGG-CALVÉ-PERTHES DISEASE

ESTUDO RADIOGRÁFICO DO ESPAÇO ARTICULAR MEDIAL DO QUADRIL NA DOENÇA DE LEGG-CALVÉ-PERTHES

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To evaluate medial joint space in affected and normal contralateral hips in patients with Legg-Calvé-Perthes disease (LCPD).

Methods: To compare joint space, femoral head extrusion (FHE), medial space coefficient (MSC) of the hip, and femoral head width (FHW) in affected and normal hips, using 127 radiographs of patients with unilateral LCPD and considering age groups under and over six years old as well as their disease stage.

Results: No statistically significant differences were observed regarding MSC between normal and affected hips regardless of disease staging. However, medial joint distance was significantly greater in affected hips than in normal hips. In the necrosis and fragmentation phase, distance from medial space in affected hips was significantly greater than in contralateral normal hips. Comparing only affected hips, MSC and FHW showed statistically significant differences and the group > 6 yo presented higher values. Among normal hips, the group < 6 yo presented a statistically significant difference considering the MSC and FHW.

Conclusions: No statistically significant difference was found between the medial joint space of affected and normal hips, except for early stages of the disease (necrosis and fragmentation). The isolated use of radiographic study is insufficient in LCPD and the lack of complementation with other exams, such as magnetic resonance, can delay diagnosis of and onset of treatment for the disease. Level of Evidence III, Study of Non Consecutive Patients; without Consistently Applied Reference “Gold” Standard.

Keywords:
Legg-Calvé-Perthes Disease; Radiography; Classification; Child

Evolutionary phase	Patients	Variable	Minimum	Maximum	Mean	p
Necrosis	55	normal hip	0.10	0.50	0.25	0.047
Necrosis	55	affected hip	0.06	0.33	0.22	0.047
Fragmentation	42	normal hip	0.09	0.44	0.21	0.790
Fragmentation	42	affected hip	0.08	0.33	0.22	0.790
Reossification	21	normal hip	0.10	0.85	0.26	0.079
Reossification	21	affected hip	0.11	0.31	0.21	0.079
Definitive	9	normal hip	0.11	0.33	0.20	0.767
Definitive	9	affected hip	0.13	0.34	0.21	0.767

Phase	Variable	n	Mean	SD	Minimum	Maximum	P25	Median	P75	p
Necrosis	CD	55	2.04	1.24	0.40	4.00	0.70	2.4	3.00	0.543
	EF	55	2.06	1.05	0.50	4.00	1.00	2.20	3.00
	Normal side relationship	55	0.25	0.10	0.01	0.50	0.15	0.25	0.30	0.047 (*)
	Affected side relationship	55	0.22	0.06	0.09	0.33	0.17	0.22	0.26
Fragmentation	CD	42	1.55	1.24	0.40	4.50	0.60	0.80	2.80	0.001 (*)
	EF	42	1.80	1.24	0.40	4.50	1.00	1.05	3.00
	Normal side relationship	42	0.21	0.09	0.09	0.44	0.15	0.18	0.27	0.790
	Affected side relationship	42	0.22	0.07	0.08	0.33	0.16	0.22	0.27
Reossification	CD	21	2.25	1.32	0.50	4.00	0.70	2.80	3.40	0.226
	EF	21	2.13	0.98	0.50	3.5	1.10	2.50	3.00
	Normal side relationship	21	0.26	0.15	0.10	0.85	0.18	0.22	0.30	0.079
	Affected side relationship	21	0.21	0.05	0.11	0.31	0.17	0.20	0.24
Definitive	CD	9	1.52	1.37	0.40	3.5	0.55	0.70	3.25	0.361
	EF	9	1.68	1.17	0.50	3.7	0.75	1.30	2.90
	Normal side relationship	9	0.20	0.07	0.11	0.33	0.13	0.18	0.26	0.767
	Affected side relationship	9	0.21	0.08	0.13	0.34	0.15	0.16	0.30

Variable	Group	n	Mean	SD	Minimum	Maximum	P25	Median	P75	p
CMSA	Up to six years old	41	3.79	1.48	1.39	9.33	2.91	3.56	4.57	0.026 (*)
	Over six years old	65	4.38	1.59	1.88	9.80	3.36	4.05	5.13
EFHA	Up to six years old	41	38.01	83.33	- 28.00	280.00	4.75	9.45	20.00	0.170
	Over six years old	65	17.37	47.19	- 5.00	290.00	3.78	6.33	13.10
WFHA	Up to six years old	41	3.68	1.62	2.55	10.66	2.80	3.15	3.7	0.012 (*)
	Over six years old	65	4.19	1.67	2.30	10.33	3.05	3.8	4.93

Variable	Group	n	Mean	SD	Minimum	Maximum	P25	Median	P75	p
CMSN	Up to six years old	41	3.63	1.29	1.18	8.00	2.82	3.30	4.57	< 0.001 (*)
	Over six years old	65	4.53	1.20	1.18	8.00	3.67	4.56	5.00
NFHE	Up to six years old	41	22.45	59.49	- 6.50	290.00	4.16	6.00	9.68	0.810
	Over six years old	65	15.09	47.34	- 25.00	280.00	3.69	7.00	10.34
NFHW	Up to six years old	41	3.31	1.42	1.24	8.47	2.35	2.70	4.14	0.006 (*)
	Over six years old	65	4.10	1.62	1.24	10.20	2.70	4.13	5.43

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[TFN1] CD: medial joint space of the affected hip; EF: medial joint space of the normal hip; n: number of cases; SD: standard deviation; p: result of the statistical calculation.