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New insights into the biomechanics of Legg-Calvé-Perthes’ disease: The role of epiphyseal skeletal immaturity in vascular obstruction

Pinheiro, M.; Dobson, C. A.; Perry, D.; Fagan, M. J.

Authors

M. Pinheiro

C. A. Dobson

D. Perry



Abstract

Objectives
Legg–Calvé–Perthes’ disease (LCP) is an idiopathic osteonecrosis of the femoral head that is most common in children between four and eight years old. The factors that lead to the onset of LCP are still unclear; however, it is believed that interruption of the blood supply to the developing epiphysis is an important factor in the development of the condition.

Methods
Finite element analysis modelling of the blood supply to the juvenile epiphysis was investigated to understand under which circumstances the blood vessels supplying the femoral epiphysis could become obstructed. The identification of these conditions is likely to be important in understanding the biomechanics of LCP.

Results
The results support the hypothesis that vascular obstruction to the epiphysis may arise when there is delayed ossification and when articular cartilage has reduced stiffness under compression.

Conclusion
The findings support the theory of vascular occlusion as being important in the pathophysiology of Perthes disease.

Citation

Pinheiro, M., Dobson, C. A., Perry, D., & Fagan, M. J. (2018). New insights into the biomechanics of Legg-Calvé-Perthes’ disease: The role of epiphyseal skeletal immaturity in vascular obstruction. Bone & joint research, 7(2), 148-156. https://doi.org/10.1302/2046-3758.72.bjr-2017-0191.r1

Acceptance Date Nov 21, 2017
Online Publication Date Feb 7, 2018
Publication Date Feb 1, 2018
Deposit Date Feb 13, 2018
Publicly Available Date Feb 13, 2018
Journal Bone and Joint Research
Print ISSN 2046-3758
Electronic ISSN 2046-3758
Publisher British Editorial Society of Bone and Joint Surgery
Peer Reviewed Peer Reviewed
Volume 7
Issue 2
Pages 148-156
DOI https://doi.org/10.1302/2046-3758.72.bjr-2017-0191.r1
Keywords Perthes’ disease; Vessel obstruction; Juvenile hip; Biomechanics; Finite element analysis
Public URL https://hull-repository.worktribe.com/output/590078
Publisher URL http://bjr.boneandjoint.org.uk/content/7/2/148
Copyright Statement © 2018 Pinheiro et al. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY -NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.

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Publisher Licence URL
http://creativecommons.org/licenses/by-nc/4.0/

Copyright Statement
© 2018 Pinheiro et al. This is an open-access article distributed under the terms of the Creative Commons Attributions licence (CC-BY -NC), which permits unrestricted use, distribution, and reproduction in any medium, but not for commercial gain, provided the original author and source are credited.







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