title: Operative versus nonoperative treatments for Legg-Calvé-Perthes disease: a meta-analysis.
abstract: BACKGROUND
  Legg-Calvé-Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head primarily affecting children of ages 4 to 12 years. There is no clear consensus on nonoperative or operative treatment protocols for pediatric patients presenting with LCPD. This study uses meta-analysis and a binary logistic regression model to analyze the radiographic outcomes of these treatment modalities in pediatric patients.
  
  
  METHODS
  Clinical studies describing patients undergoing either nonoperative or operative treatment of LCPD published from 1960 through 2010 were searched electronically and manually. Eligible studies consisted of (1) a minimum of 10 patients; (2) listed age at the time of diagnosis or treatment; (3) performed an initial severity assessment using the Herring or Catterall classification; (4) detailed the type of intervention; and (5) reassessment of radiographic outcome after a minimum of 1 year after treatment using the Mose or Stulberg classification.
  
  
  RESULTS
  Twenty-three studies, 1232 patients, and 1266 hips met the inclusion criteria. Among patients younger than 6 years, operative and nonoperative treatments are equally as likely to results in a successful radiographic outcome [odds ratio (OR)=1.071; P=0.828; 95% confidence interval (CI), 7.377-32.937]. In patients older than 6 years, operative treatment is nearly twice as likely to result in a successful radiographic outcome (OR=1.754; P<0.0001; 95% CI, 1.299-2.370). For age at treatment less than 6 years, a patient treated with a pelvic rather than femoral procedure was approximately 5 times as likely to have a good radiographic outcome (χ=4.488; P=0.034; unadjusted OR=5.20; 95% CI, 1.021-26.471). Among patients ages 6 or older, pelvic procedures were equally as likely as femoral procedures to yield a successful radiographic outcome (χ=1.845; P=0.174; unadjusted OR=1.329; 95% CI, 0.881-2.004). Sex had no significant influence on radiographic outcome (OR=1.248; P=0.486; 95% CI, 0.670-2.325).
  
  
  CONCLUSIONS
  This meta-analysis suggests that operative treatment is more likely to yield a spherical congruent femoral head than nonoperative methods among patients 6 years or older. Among patients younger than 6 years, operative and nonoperative methods have the same likelihood to yield a good outcome. Patients who were 6 years or older were treated operatively, and had the same likelihood of a good radiographic outcome regardless of treatment with femoral or pelvic procedures. Among patients younger than 6 years, pelvic procedures were more likely to result in a good radiographic outcome than femoral procedures.
  
  
  METHODS
  Level IV meta-analysis.
authors.affiliation: Ohio University College of Osteopathic Medicine, Athens, OH, USA.
authors.forename: Nhu-An T
authors.initials: NA
authors.lastname: Nguyen
authors.forename: Guy
authors.initials: G
authors.lastname: Klein
authors.forename: Godwin
authors.initials: G
authors.lastname: Dogbey
authors.forename: Jessica B
authors.initials: JB
authors.lastname: McCourt
authors.forename: Charles T
authors.initials: CT
authors.lastname: Mehlman
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016015:Logistic Models; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome