Browsing by Subject "Legg-Calve-Perthes Disease"
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Item Development of Ex Vivo Femoral Head Deformity Model to Test Restorative Surgical Techniques(2022-02-01) Edwards, David; Niese, Brad; Ma, Chi; Kim, Harry K.W.Legg-Calve-Perthes disease (LCPD) is a childhood ischemic hip disorder which produces femoral head deformity due to weakened bone structure. The femoral head deformity causes pain, stiffness, and debilitating osteoarthritis; if left untreated, a total hip replacement is eventually required. Currently there is no reliable ex-vivo deformity model to develop and test the efficacy of new surgical devices and methods to improve the deformity and to restore the round shape. We hypothesize that a reliable model of deformity comparable to LCPD can be created using porcine cadaver bone by applying compressive force methods. Due to the availability of porcine humeral heads in the lab, we performed our preliminary studies using the humeral heads. We tested four mechanical approaches. Our first approach involved the application of static and cyclic compressions to mature humeral heads. However, the method failed to deform the heads due the high compressive strength of the mature bone. Our second approach involved drilling into the mature heads to create stress risers before applying the compression forces. This resulted in undesirable fracture of the bone. Our third approach used juvenile porcine humeral heads with cyclic compressions which resulted in deformity, but was inconsistent in the number of cycles required to achieve the appropriate deformity. Finally, we successfully achieved a reliable deformity model resembling LCPD by mounting juvenile humeral heads in a specific orientation and applying successive increases in static compression force at 50, 100, 150, 200, and 250 lbs using a Bose Electroforce 3330 test instrument. The amount of collapse after each static compression was measured using calipers. Identical measurements were taken after each compression test, up to 250lbs of force. This method created a 2 mm collapse of the humeral head which was reproducible. In summary, we developed a novel ex-vivo model of deformity which will facilitate the development of new restorative surgical devices and techniques to improve the femoral head deformity of LCPD.Item Quantitative Assessment of Synovitis in Legg-Calve-Perthes Disease Using Gadolinium Enhanced MRI(2016-04-01) Neal, David Charles; Kim, Harry K. W.; Barker, Blake; Green, GordonPURPOSE: Hip synovitis in LCPD is associated with pain, decreased motion, and poor outcome. However, a reliable quantitative method to assess hip synovitis, its progression, and response to therapy is not currently available. Gadolinium MRI (Gd-MRI) has been used to assess synovitis in other inflammatory conditions, but no study has been performed to quantify hip synovitis in LCPD. Purposes of the study are to develop a reliable quantitative method to measure hip synovitis using Gd-MRI in LCPD and to determine the temporal progression of synovitis. METHODS: 22 patients (22 hips) were enrolled based on the following criteria: first Gd-MRI obtained during active stage of LCPD (Waldenström Stage I to II) and serial MRI obtained using the same protocol (average number of MRIs 3±1, range 2-6). The areas of synovial enhancement in all slices of Gd-MRIs were measured using digital image analysis software. Individual areas were converted to volumes and the measurements were compared over time and Waldenström stage of disease. Intra-/ inter-observer reliabilities of measurements were assessed by 2 independent observers. Intraclass correlation coefficient (ICC) was analyzed. Total volume of synovitis was compared between the affected and unaffected sides using a t-test with statistical significance at p<0.05. RESULTS: Age at diagnosis ranged from 5 to 11 years (mean 7.4 ± 1.6). The first Gd-MRI was obtained at a mean duration of 1.0 ± 1.2 months after diagnosis (range 0 - 3 months). Synovial enhancement on initial Gd-MRI was significantly higher on the affected side (7031 ± 3109 mm3) vs. the unaffected side (367 ± 308 mm3, p<0.001). On final MRI, mean synovial enhancement was 4184 ± 3030 mm3 on the affected vs. 484 ± 415 mm3 (p<0.001) on the unaffected side (Figure 1). Mean synovial enhancement (synovitis) decreased with progression of Waldenström Staging from Stage I (avg. 7535 ± 3524 mm3) to Stage III (avg. 3800 ± 2413 mm3). The intraclass correlation coefficient was 0.98. The interobserver agreement was 0.94 CONCLUSION: Synovitis is highly prevalent in LCPD and most severe during the early stages of the disease. Overall, synovitis decreased within the first 20 months after diagnosis. This decrease correlated with the progression of the Waldenström stage. SIGNIFICANCE: A reliable quantitative method to assess synovitis in LCPD using Gd-MRI was developed. LCPD is associated with chronic synovitis which decreased with Waldenström stage.Item Weightbearing and Activity Restriction Treatments and Quality of Life in Patients with Perthes Disease(2021-05-01T05:00:00.000Z) Do, Dang-Huy; Kim, Harry K. W.; Huo, Michael; Wells, JoelBACKGROUND: Weightbearing and activity restrictions are commonly prescribed during the active stages of Perthes disease. These restrictions, ranging from cast or brace treatment with nonweightbearing to full weightbearing with activity restrictions, may have a substantial influence on the physical, mental, and social health of a child. However, their impact on the patient's quality of life is not well-described. OBJECTIVES: After controlling for confounding variables, are restrictions on weightbearing and activity associated with physical health measures (as expressed by the Patient-Reported Outcome Measurement Information System [PROMIS] mobility, PROMIS pain interference, and PROMIS fatigue), mental health measures (PROMIS depressive symptoms and PROMIS anxiety), and social health measures (PROMIS peer relationships)? METHODS: Between 2013 and 2020, 211 patients with Perthes disease at a single institution were assigned six PROMIS measures to assess physical, mental, and social health. Patients who met the following eligibility criteria were analyzed: age 8 to 14 years old, completion of six PROMIS measures, English-speaking, and active stage of Perthes disease (Waldenstrom Stage I, II, or III). Weightbearing and activity restrictions were clinically recommended to patients in the initial through early reossification stages of Perthes disease when patients had increasing pain, loss of hip motion, loss of hip containment, progression of femoral head deformity, increased hip synovitis, and femoral head involvement on magnetic resonance imaging (MRI), or as a postoperative regimen. Patients were categorized into four intervention groups based on weightbearing and activity regimen. We excluded 111 patients who did not meet the inclusion criteria. The following six pediatric self-report PROMIS measures were assessed: mobility, pain interference, fatigue, depressive symptoms, anxiety, and peer relationships. Analysis of variance (ANOVA) was used to compare differences between the mean PROMIS T-scores of these weightbearing/activity regimens. Results were assessed with a significance of p < 0.05 and adjusted for Waldenstrom stage, gender, age of diagnosis, and history of major surgery using multivariate regression analysis. RESULTS: After controlling for confounding variables, the mild- (β regression coefficient -15 [95% CI -19 to -10]; p < 0.001), moderate- (β -19 [95% CI -24 to -14]; p < 0.001), and severe- (β -25 [95% CI -30 to -19]; p < 0.001) restriction groups were associated with worse mobility T-scores compared with the no-restriction group, but no association was detected for the pain interference or fatigue measures. Weightbearing and activity restrictions were not associated with mental health measures (depressive symptoms and anxiety). Weightbearing and activity restrictions were not associated with social health measures (peer relationships). Earlier Waldenstrom stage was associated with worse pain interference (β 10 [95% CI 2 to 17]; p = 0.01) and peer relationships scores (β -8 [95% CI -15 to -1]; p = 0.03); female gender was linked with worse depressive symptoms (β 7 [95% CI 2 to 12]; p = 0.005) and peer relationships scores (β -6 [95% CI -12 to 0]; p = 0.04); and earlier age at diagnosis was associated with worse peer relationships scores (β 1 [95% CI 0 to 2]; p = 0.03). History of major surgery had no connection to any of the six PROMIS measures. CONCLUSION: We found that weightbearing and activity restriction treatments are associated with poorer patient-reported mobility in the active stages of Perthes disease after controlling for confounding variables, but not pain interference, fatigue, depressive symptoms, anxiety, or peer relationships. Understanding how these treatments are associated with Perthes disease patients' quality of life can aid in decision-making for providers, help set expectations for patients and their parents, and provide opportunities for better education and preparation. Because of the chronic nature of Perthes disease, future studies may focus on longitudinal trends in patient-reported outcomes to better understand the overall impact of this disease and its treatment.