Poorer health-related quality of life in patients with Legg-Calvé-Perthes disease: A systematic review of clinical implications for care.

BACKGROUND

Legg-Calvé-Perthes disease (LCPD) is a childhood hip disorder associated with pain, impaired mobility, and prolonged treatment that may negatively affect health-related quality of life (HRQoL). We examined whether LCPD is associated with worse (1) pain, functional, and overall health-related quality-of-life outcomes, as well as a higher prevalence of (2) attention-deficit/hyperactivity disorder (ADHD), (3) vascular disease and obesity, and (4) depression and anxiety.

METHODS

This systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD42023476026). We queried the PubMed, Google Scholar, and EBSCOhost databases for articles evaluating LCPD and its HRQoL associations. Eligibility screening was performed independently by two reviewers, yielding 21 articles that were published between 1988 and 2023. Risk of bias was assessed using the Methodological Index for Nonrandomized Studies. Results were synthesized qualitatively.

RESULTS

Several studies reported increased rates of ADHD symptoms and behavioral difficulties among children with LCPD, particularly during earlier stages of disease and the initial period following diagnosis. Patients with LCPD report inferior pain and function as well as increased rates of depression. Several studies reported postoperative improvements in pain, function, and mental health outcomes following surgical intervention. Compared to controls, patients with LCPD have a 2-fold increased risk of hypertension and a 1.5-fold increased risk of obesity; however, the temporal relation remains poorly understood. Specific risk factors for inferior HRQoL among patients with LCPD include a more severe Stulberg class, earlier disease stage, older age at onset, and the female sex.

CONCLUSION

LCPD is associated with a host of HRQoL concerns. However, with post diagnostic psychosocial support and surgical intervention, when indicated, these patients can show improved pain, function, mental health, and attentiveness.

REGISTRATION: PROSPERO registration of the study protocol: 2023476026.

LEVEL OF EVIDENCE: III.