Radiographic outcomes and prognostic factors after protocol-defined prolonged abduction containment for Legg-Calvé-Perthes disease: a 427-hip retrospective cohort study.
- 1The Third Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
- 2Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
- 3Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China. [email protected].
Abstract
Background
Evidence on nonoperative treatment for Legg-Calvé-Perthes disease remains limited by heterogeneity in treatment exposure, including variable combinations of observation, physiotherapy, bracing, casting, activity restriction, and weight-bearing restriction. We evaluated radiographic outcomes and risk factors after a protocol-defined prolonged cast-based abduction containment regimen, thereby establishing benchmark outcome estimates for this specific nonoperative pathway.Methods
This single-center retrospective cohort study included children with Legg-Calvé-Perthes disease treated with the institutional protocol between 2009 and 2022 and followed radiographically to healing. The protocol consisted of continuous cast-based abduction containment and strict non-weight-bearing until radiographic healing. The primary outcome was an adverse radiographic result at healing, defined as modified Stulberg grade III to V. Hip-level associations were evaluated using generalized estimating equations with an independence working correlation structure and patient-clustered robust standard errors to account for correlation between bilateral hips.Results
A total of 398 children with 427 hips were included; 110 hips (25.8%) had an adverse radiographic outcome. Adverse outcome rates increased across age groups: 15.8% in children younger than 6 years, 24.1% in children aged 6 to < 8 years, and 39.8% in children aged 8 years or older. In the primary multivariable model, compared with children younger than 6 years, the odds of adverse outcome were higher in children aged 6 to < 8 years (OR 2.16, 95% CI 1.13 to 4.15; p = 0.020) and in those aged 8 years or older (OR 5.69, 95% CI 2.77 to 11.71; p < 0.001). Compared with Herring A/B hips, Herring B/C hips (OR 2.19, 95% CI 1.07 to 4.49; p = 0.032) and Herring C hips (OR 10.28, 95% CI 5.50 to 19.22; p < 0.001) had higher odds of adverse outcome. Sensitivity analyses showed the same overall pattern.Conclusions
Within this defined nonoperative pathway, older age at diagnosis and greater Herring lateral pillar involvement were associated with a higher risk of adverse radiographic outcome at healing. These protocol-specific estimates provide a reference for prognostic counselling within this treatment pathway and a benchmark for future comparative studies of nonoperative strategies.Trial registration
Chinese Clinical Trial Registry, ChiCTR2600120879, 20 March 2026, retrospectively registered.
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BibTeX
@article{xia2026radiographic,
title = {{Radiographic outcomes and prognostic factors after protocol-defined prolonged abduction containment for Legg-Calvé-Perthes disease: a 427-hip retrospective cohort study.}},
author = {Tiantian Xia and Fengjie Zhang and Jiaru Liao and Xiaoqiang Yang and Fan Yang and Wei He and Ziqi Li},
journal = {BMC musculoskeletal disorders},
year = {2026},
month = jul,
doi = {10.1186/s12891-026-10291-4},
url = {https://europepmc.org/article/MED/42928191},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Radiographic outcomes and prognostic factors after protocol-defined prolonged abduction containment for Legg-Calvé-Perthes disease: a 427-hip retrospective cohort study.
AU - Tiantian Xia
AU - Fengjie Zhang
AU - Jiaru Liao
AU - Xiaoqiang Yang
AU - Fan Yang
AU - Wei He
AU - Ziqi Li
PY - 2026
DA - 2026/07/29
JO - BMC musculoskeletal disorders
DO - 10.1186/s12891-026-10291-4
UR - https://europepmc.org/article/MED/42928191
AB - Background Evidence on nonoperative treatment for Legg-Calvé-Perthes disease remains limited by heterogeneity in treatment exposure, including variable combinations of observation, physiotherapy, bracing, casting, activity restriction, and weight-bearing restriction. We evaluated radiographic outcomes and risk factors after a protocol-defined prolonged cast-based abduction containment regimen, thereby establishing benchmark outcome estimates for this specific nonoperative pathway.Methods This single-center retrospective cohort study included children with Legg-Calvé-Perthes disease treated with the institutional protocol between 2009 and 2022 and followed radiographically to healing. The protocol consisted of continuous cast-based abduction containment and strict non-weight-bearing until radiographic healing. The primary outcome was an adverse radiographic result at healing, defined as modified Stulberg grade III to V. Hip-level associations were evaluated using generalized estimating equations with an independence working correlation structure and patient-clustered robust standard errors to account for correlation between bilateral hips.Results A total of 398 children with 427 hips were included; 110 hips (25.8%) had an adverse radiographic outcome. Adverse outcome rates increased across age groups: 15.8% in children younger than 6 years, 24.1% in children aged 6 to < 8 years, and 39.8% in children aged 8 years or older. In the primary multivariable model, compared with children younger than 6 years, the odds of adverse outcome were higher in children aged 6 to < 8 years (OR 2.16, 95% CI 1.13 to 4.15; p = 0.020) and in those aged 8 years or older (OR 5.69, 95% CI 2.77 to 11.71; p < 0.001). Compared with Herring A/B hips, Herring B/C hips (OR 2.19, 95% CI 1.07 to 4.49; p = 0.032) and Herring C hips (OR 10.28, 95% CI 5.50 to 19.22; p < 0.001) had higher odds of adverse outcome. Sensitivity analyses showed the same overall pattern.Conclusions Within this defined nonoperative pathway, older age at diagnosis and greater Herring lateral pillar involvement were associated with a higher risk of adverse radiographic outcome at healing. These protocol-specific estimates provide a reference for prognostic counselling within this treatment pathway and a benchmark for future comparative studies of nonoperative strategies.Trial registration Chinese Clinical Trial Registry, ChiCTR2600120879, 20 March 2026, retrospectively registered.
SN - 1471-2474
ER -