Legg–Calvé–Perthes disease presenting with osteoarthritis: Mechanisms of the development and prospects of conservative therapy using bisphosphonates

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BACKGROUND: Aseptic necrosis of the femoral head in children remains a subject of great interest among specialists, despite its long history of study. The Legg–Calvé–Perthes disease is the most common form of aseptic necrosis of the femoral head in children. The necrotic lesion in the femoral head results from the blockage of the arterial blood supply to the epiphysis, leading to its infarction. Some children experience a more aggressive disease course, with signs of osteoarthritis, which can result in the early development of coxarthrosis. Numerous publications have demonstrated the successful use of bisphosphonates in adult patients with aseptic necrosis of the femoral head.

AIM: To generalize data on the use of bisphosphonates in children with the Legg–Calvé–Perthes disease presenting with signs of osteoarthritis through the analysis of contemporary global literature.

MATERIALS AND METHODS: A literature search was conducted in the open databases of PubMed, Science Direct, and Google Scholar, and the analysis depth spanned 20 years. The search terms used included “Legg–Calvé–Perthes disease,” “aseptic (avascular) necrosis of the femoral head,” and “bisphosphonates.” The review encompassed the literature on bisphosphonates, their biological action, effectiveness of their use in patients with aseptic necrosis of the femoral head, and results of our research.

RESULTS: Studies on the efficacy of bisphosphonates in children with Legg–Calvé–Perthes disease are limited. Currently, the effect of bisphosphonates on disease course and outcome is unknown. Despite this, mechanisms of chronic inflammation are increasingly mentioned in the literature, which may directly or indirectly influence the clinical course and outcome of the disease. The key is the hyperactivity of osteoclasts in osteonecrosis. The experience of using bisphosphonates in adult patients with aseptic necrosis of the femoral head had positive results in preventing the progression of the deformity of femoral head deformity.

CONCLUSIONS: Bisphosphonates are specific inhibitors of osteoclast activity, which has been used in many diseases. The results and inferences of using bisphosphonates in children with Legg–Calvé–Perthes disease will lead to the formulation of a new treatment algorithm.

作者简介

Aleksei Kozhevnikov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery; Saint Petersburg State Pediatric Medical University

编辑信件的主要联系方式.
Email: infant_doc@mail.ru
ORCID iD: 0000-0003-0509-6198
SPIN 代码: 1230-6803
Scopus 作者 ID: 57193337958

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Dmitrii Barsukov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN 代码: 2454-6548

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Aigul Gubaeva

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: little1ashley3@yandex.ru
ORCID iD: 0000-0002-7056-4923

MD, resident

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Magnetic resonance imaging shows the initial stage of ANFH (from the author’s archive). A magnetic resonance imaging scan reveals osteonecrosis of the femoral head on the right, massive trabecular edema, as well as pronounced symptoms of synovitis with overstretching of the joint capsule

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3. Fig. 2. Scheme of osteoclast activation in the focus of osteonecrosis (from the author’s archive). Explanation is presented in the text. RANK, cellular receptor activator; RANKL, receptor ligand; IL-6, interleukin-6; IL-1, interleukin-1, TNF-α, tumor necrosis factor alpha

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4. Fig. 3. Magnetic resonance imaging shows stage 2 of osteochondropathy of the femoral head on the left with signs of osteoarthritis (from the author’s archive). Magnetic resonance imaging in T2 STIR modes reveals an extensive area of femoral head destruction, signs of trabecular edema, and chronic synovitis

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5. Fig. 4. A series of magnetic resonance imaging in pediatric patients with LCPD with signs of osteoarthritis: (a, b) without subluxation in the affected joint; (c, d) with subluxation of the femoral head (from the author’s archive)

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