Clin Orthop Surg.  2009 Dec;1(4):222-229. 10.4055/cios.2009.1.4.222.

Prognostic Value of Modified Lateral Pillar Classification in Legg-Calve-Perthes Disease

• Lee DS
• Jung ST
• Kim KH
• Lee JJ

• KMID: 999405
• DOI: http://doi.org/10.4055/cios.2009.1.4.222

Abstract

BACKGROUND
To evaluate the usefulness of the modified lateral pillar classification as a prognostic factor in Legg-Calve-Perthes disease (LCPD).
METHODS
Thirty nine patients diagnosed with lateral pillar C in LCPD from May, 1977, to October, 2001 were reviewed, and their skeletal maturity was followed. The mean follow up duration was 12 years and 7 months (4 years, 6 months to 24 years, 9 months). Lateral pillar C classification was divided into C1 (50-75% collapse of the lateral pillar) and C2 (> 75%). All radiological and clinical prognostic factors were evaluated. The final results were evaluated according to the Stulberg classification.
RESULTS
Twenty one and 18 of the affected hips were in groups C1 and C2, respectively. According to the Stulberg classification, the final results of group C1 were better than those of C2 (p = 0.002). Patients with more head-at-risk signs had significantly poorer outcomes.
CONCLUSIONS
The modified lateral pillar classification has significant value for predicting the prognosis of LCPD.

Keyword

Legg-Perthes disease; Lateral pillar classification; Prognosis

MeSH Terms

Adolescent
Adult
Chi-Square Distribution
Child
Child, Preschool
Female
Femur Head/*pathology/radiography
Follow-Up Studies
Hip Joint/*pathology/radiography
Humans
Legg-Perthes Disease/*classification/*pathology/radiography/therapy
Male
Predictive Value of Tests
Prognosis
Treatment Outcome
Young Adult

Figure

• 

  Fig. 1 Schematic view of the modified lateral pillar C classification of Legg-Calvé-Perthes disease.

• 

  Fig. 2 Relation of the modified lateral pillar C classification with the Stulberg classification (chi-square test, p = 0.002).

• 

  Fig. 3 (A) An example of a left hip in group C1 of the modified lateral pillar classification in a patient who was 5.5 years old at presentation. This radiograph shows three radiographical head-at-risk signs, lateral subluxation of femoral head, calcification lateral to epiphysis and diffuse metaphyseal reaction. (B) Anteroposterior and frog-leg lateral radiograph of the pelvis made at the age of eighteen years showing a Stulberg II femoral head with slight differences between the two hips. The patient was treated with a brace.

• 

  Fig. 4 (A) An example of a right hip in group C1 of the modified lateral pillar classification in a patient who was 4.3 years old at presentation. The radiograph shows the four radiographical head-at-risk signs, lateral subluxation of femoral head, Gage's sign, calcification lateral to epiphysis and diffuse metaphyseal reaction. (B) Anteroposterior and frog-leg lateral radiograph of the pelvis, made at the age of sixteen years, showing the Stulberg III femoral head with marked differences between the two hips. The patient was treated with skin traction followed by a cast and with brace one year later.

• 

  Fig. 5 (A) An example of a left hip in group C2 of the modified lateral pillar classification in a patient who was 5.6 years old at presentation. This radiograph shows the two radiographical head-at-risk signs, Gage's sign and a diffuse metaphyseal reaction. (B) Anteroposterior and frog-leg lateral radiograph of the pelvis, made at the age of seventeen years, showing the Stulberg II femoral head with a decreased neck-shaft angle. The patient was treated with a brace.

• 

  Fig. 6 (A) An example of a right hip in group C2 of the modified lateral pillar classification in a patient who was 3.2 years old at presentation. This radiograph shows three significant radiographical head-at-risk signs, lateral subluxation of the femoral head, calcification lateral to the epiphysis, Gage's sign and a diffuse metaphyseal reaction. Among them, only three signs were related to the prognosis. (B) Anteroposterior and frog-leg lateral radiograph of the pelvis, made at the age of fifteen years, showing the Stulberg IV femoral head with a marked difference between the two hips. Affected hip shows a flattening of the femoral head.

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