Comparative effectiveness of treatment modalities in severe Legg‑Calvé‑Perthes disease: Systematic review and network meta‑analysis of observational studies
3
Issued Date
2022-05-01
Resource Type
ISSN
03412695
eISSN
14325195
Scopus ID
2-s2.0-85125398271
Pubmed ID
35230467
Journal Title
International Orthopaedics
Volume
46
Issue
5
Start Page
1085
End Page
1094
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Orthopaedics Vol.46 No.5 (2022) , 1085-1094
Suggested Citation
Adulkasem N., Phinyo P., Tangadulrat P., Wongcharoenwatana J., Ariyawatkul T., Chotigavanichaya C., Kaewpornsawan K., Eamsobhana P. Comparative effectiveness of treatment modalities in severe Legg‑Calvé‑Perthes disease: Systematic review and network meta‑analysis of observational studies. International Orthopaedics Vol.46 No.5 (2022) , 1085-1094. 1094. doi:10.1007/s00264-022-05352-x Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85938
Title
Comparative effectiveness of treatment modalities in severe Legg‑Calvé‑Perthes disease: Systematic review and network meta‑analysis of observational studies
Author's Affiliation
Other Contributor(s)
Abstract
Purpose: There are several treatment modalities for Legg-Calvé-Perthes disease (LCPD), self-limiting, avascular osteonecrosis of the femoral head in children. Most treatments focus on containment of the weakened femoral head, but there is no consensus on the best modality for severe LCPD. Therefore, we compared the effectiveness of all treatment modalities for severe LCPD. Materials and methods: We searched the PubMed, Embase, and Scopus up until July 2021 for studies that investigated LCPD treatment effectiveness. A network meta-analysis was performed to examine the comparative effectiveness in terms of the ability to achieve radiographic spherical congruity of the hip joint after skeletal maturity. The risk ratio (RR) and 95% confidence interval (CI) of each treatment modality were estimated from both direct and indirect evidence. Treatment ranking was based on Surface Under the Cumulative Ranking curve (SUCRA). Results: A total of 857 studies were identified and 34 comparative studies with 3718 affected hips comparing seven different LCPD treatment modalities were included. Compared with symptomatic treatment, combined osteotomy was the most effective modality (RR = 1.47, 95% CI 0.90 to 2.42, SUCRA = 0.8), followed by femoral varus osteotomy (RR = 1.31, 95% CI 1.06 to 1.60, SUCRA = 0.7), and Salter innominate osteotomy (RR = 1.25, 95% CI 0.95 to 1.65, SUCRA = 0.6). Conclusions: Combined osteotomy is the most effective procedure in terms of improving the spherical congruity of the hip joint in severe LCPD patients. However, the superiority of operative treatments seems to be limited to patients older than eight years old.