Last updated on April 2019

Multicenter Prospective Cohort Study on Current Treatments of Legg-Calv -Perthes Disease


Brief description of study

Legg-Calv-Perthes disease is a childhood hip disorder which is common enough to be a significant public health problem (affects 1 in 740 boys between ages 014), but uncommon enough to have a sufficient number of patients from a single institution to perform a definitive prospective study comparing the results of current treatments. The present study will establish a database of prospectively identified patients with Legg-Calv-Perthes (LCP) Disease and collect information regarding their presentation, treatment, and outcomes in the course of receiving currently available treatments.

This study seeks to compare the outcomes of current treatments in the management of different age groups (ages 1-6, 68, 811, >11) of patients with Perthes disease at two- and five-year followup and at skeletal maturity. For each age group, two to three common treatment regimens currently used by practicing pediatric orthopaedic surgeons will be compared. The intervention a patient receives is determined through physician preference. Physicians pick an intervention for each age group and treat each patient with the same intervention.

Detailed Study Description

Approximately 50 pediatric orthopaedic surgeons from pediatric centers in the US and other countries have agreed to participate in this database as members of the International Perthes Study Group (IPSG). TSRH will be the lead center. Those who agree to participate will seek IRB approval from their own institutions. Data will be collected prospectively and entered into REDCap (Research Electronic Data Capture), a browser-based research database. Patient Reported Outcomes Measurement Information System (PROMIS) questionnaires will be completed via an online testing system, the NIH funded Assessment Center.

1-6 Cohort: For the 1-6 age patient group, patients presenting in an early stage of the disease (stage I or IIa), the surgeons who treat patients with one of the following treatment regimens currently used in practice will be asked to participate in the study.

  1. Non-operative management (i.e., no osteotomy but can include soft tissue release)
  2. Operative containment treatment (femoral or pelvic osteotomy or Shelf acetabuloplasty).

6-8 Cohort: For the 68 age patient group, patients presenting in an early stage of the disease (stage I or IIa), the surgeons who treat their patients with one of the following three treatment regimens currently used in practice will be asked to participate in the study 2-4.

  1. Non-operative management (i.e., no osteotomy but can include soft tissue release);
  2. Operative containment treatment (femoral or pelvic osteotomy or Shelf acetabuloplasty).

8-11 Cohort:

For the 811 patient age group, patients presenting in an early stage of the disease (stage I or IIa), the surgeons who treat their patients with one of the following treatment regiments currently used in practice will be asked to participate in the study:

  1. Non-operative management (i.e., no osteotomy);
  2. Operative containment treatment (femoral or pelvic osteotomy or Shelf acetabuloplasty) followed by 6 weeks of postoperative non-weight bearing; and,
  3. Operative containment treatment (femoral or pelvic osteotomy or Shelf acetabuloplasty) followed by 6 months of postoperative non-weight bearing.

>11 Cohort Registry:

For the >11 patient age group, patients presenting in an early stage of the disease (stage I or IIa) we will collect prospective data from surgeons who are currently treating their patients with one of the following alternative treatment regimens 5,6:

  1. Non-operative management (i.e. no osteotomy);
  2. Core decompression or multiple epiphyseal drilling of the necrotic femoral head with post-operative non-weight bearing; or,
  3. Core decompression or multiple epiphyseal drilling of the necrotic femoral head with application of hinged hip distractor.

Patients who present to an IPSG member or their group during the late stages of the disease (stage IIb or stage III) will also be arranged into four separate age cohorts, identical to the list above. We will collect prospective data from surgeons who are currently treating these patients with operative or non-operative treatment regimens.

Regardless of the patient's stage at enrollment, the patient's age at diagnosis or assigned cohort, the following data will be collected: information regarding patient characteristics at presentation, physical exam findings, responses to Perthes patient and/or outcomes questionnaires, and results of radiographic and MR imaging. Participants will be assigned a unique study number. A secure web application, REDCap, will be used to capture and store research information including de-identified radiographic and MR images, clinical information, and Perthes patient and/or outcomes questionnaire responses.

All patients willing to complete the PROMIS questionnaires will do so regardless of group, treatment, or stage of the disease. The administration of the instrument is facilitated by the use of an online testing platform, the NIH-funded Assessment Center. Data will be transmitted and stored on a secure and dedicated server for the purpose of this study.

Clinical Study Identifier: NCT02040714

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