[Does coxitis fugax predispose for later Perthes' disease?--first results of an insurance data-based study].
BACKGROUND
For decades, it has been a matter of debate whether coxitis fugax (CF) may trigger the onset of Perthes' disease (PD). However, the low incidence of both conditions limits the validity of clinical studies. As a novel approach, an analysis of patient data provided by a private health insurance (PHI) was performed. After calculation of the frequencies of CF and PD possible correlations were statistically assessed. We hypothesised that CF predisposes to the development of PD.


METHODS
A retrospective database analysis was conducted based on insurance data of patients aged between 1 and 14 years covering an observation period of 7 years. Cases of CF and PD were detected by a search algorithm based on the International Classification System of Diseases (ICD) encoding the ICD codes M12.85 to CF and M91.1 to PD, respectively. Cases where CF was followed by PD were separately assessed for plausibility considering the clinical course and the length of the symptom-free interval. Statistical analysis was performed by using the chi-square test with a significance level set at 5 %.


RESULTS
Among a cohort of 407,875 children 960 cases of CF were detected. Of these, 876 (91.3 %) had one single event of CF whereas 84 (8.7 %) children had two or more episodes. The average incidence of CF was 0.24 % per year. The frequency of PD was calculated to be 15.7 cases per 100, 000 children per year. In eleven cases (all male) CF was found to be followed by PD, however, after checking for plausibility only three cases remained. Statistical analysis revealed that the incidence of PD in male children with a previous CF episode was 21-times higher compared to children without CF (p < 0.0001).


CONCLUSIONS
The results of the hitherto largest study including more than 400 ,000 children showed a significantly higher rate of PD in male children with previous CF compared to boys without CF. However, different patterns of age distribution and the observation that multiple CF episodes do not trigger the development of PD contradict the assumption of a possible correlation between these two diseases. In two of the three cases where CF was followed by PD a so-called "late onset PD" was evident suggesting a misdiagnosed PD at initial presentation. The chosen study design using patient data provided by a PHI allows the acquisition and evaluation of large numbers of cases which may help to elucidate possible correlations between different medical conditions. To unambiguously answer the hypothesis of this study, the inclusion of additional insurance data is necessary.
Dr. Rose/Kraneis, Orthopädische Gemeinschaftspraxis, Köln.
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Stobbe
Klinik und Poliklinik für Orthopädie und Unfallchirurgie der Uniklinik Bonn.
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Pennekamp
Anatomie, University Düsseldorf.
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Filler
Central Krankenversicherung AG, Controlling, Köln.
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Gödecke
Dres. Branner/Lieb, Orthopädische Gemeinschaftspraxis, Neufahrn.
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Lieb
Klinik und Poliklinik für Orthopädie und Unfallchirurgie der Uniklinik Bonn.
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Placzek
D000293:Adolescent; D017677:Age Distribution; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007873:Legg-Calve-Perthes Disease / Q000175:diagnosis* / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D009313:National Health Programs / Q000706:statistics & numerical data*; D015207:Osteoarthritis, Hip / Q000175:diagnosis* / Q000453:epidemiology*; D010865:Pilot Projects; D018570:Risk Assessment; D017678:Sex Distribution