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.

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