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Legg-Calve-Perthes disease and the risk of injuries requiring hospitalization A register study involving 2579 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
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2012 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 83, no 6, 572-576 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose Previous studies have suggested that Legg-Calve-Perthes disease (LCPD) is associated with repetitive trauma, coagulation problems and anatomical abnormalities of the blood supply to the femoral head. The hypothesis that repetitive trauma can affect the blood supply of the femoral head, leading to LCPD, is supported by an animal model. For evidence of an increased risk of repetitive trauma, we investigated whether patients with LCPD have a higher risk for severe injuries requiring hospitalization. Patients and methods We identified 2579 patients with LCPD in Sweden during the period 1964-2005. 13,748 individuals without LCPD were randomly selected from the Swedish general population, matched by year of birth, sex and region (control group). Cox proportional hazard regression estimated the risks. Results Compared to the control group, patients with LCPD had a modestly raised hazard ratio (HR) of 1.2 (95% CI 1.1-1.3) for injury requiring hospitalization. The risks were slightly higher for soft tissue injuries (HR = 1.3, 95% CI: 1.1-1.4) than for fractures (HR = 1.1, 95% CI: 1.0-1.3) and more pronounced among females. Compared to the control group, the higher risk for injury only applied to the lower extremities (HR = 1.2, 95% CI: 1.0-1.4) in patients with LCPD. Interpretation Patients with LCPD are vulnerable to injuries which could be interpreted as a marker of hyperactive behavior. It could also implicate that anatomical changes in the bone formation or blood supply of the femoral head-increasing its sensibility for trauma-contribute to the etiology of LCPD..

Place, publisher, year, edition, pages
2012. Vol. 83, no 6, 572-576 p.
National Category
Orthopedics
Identifiers
URN: urn:nbn:se:uu:diva-190317DOI: 10.3109/17453674.2012.736167ISI: 000311679900005OAI: oai:DiVA.org:uu-190317DiVA: diva2:585921
Available from: 2013-01-10 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Legg-Calvé-Perthes Disease – Is it just the hip?: Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology
Open this publication in new window or tab >>Legg-Calvé-Perthes Disease – Is it just the hip?: Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to add some pieces to the etiological puzzle of LCPD with special focus on vascular origin and hyperactivity. Furthermore we wanted to evaluate some consequences of LCPD in adulthood.

Swedish registry data were used to identify a cohort of patients with the diagnosis of LCPD. This cohort was compared with a general population– based cohort without LCPD to assess the relative risk of cardiovascular diseases, blood or coagulation defects, injury, ADHD, depression and mortality.

In a clinical study we assessed health-related quality of life (EQ-5D-3L), physical activity level (IPAQ) and screened for ADHD (ASRSv1.1) in 116 patients with a history of LCPD who were diagnosed or treated in Uppsala University Hospital between 1978 and 1995.

The results confirmed our hypothesis: Patients with a history of LCPD had a 1.7-fold higher risk of cardiovascular diseases, and a 1.4-fold higher risk for blood or coagulation defects compared with gender- and age-matched individuals without LCPD. We found a 1.2-fold higher risk for injuries requiring hospital admission than in gender- and age-matched individuals without LCPD. The risk was more pronounced among females. Furthermore, we found a 1.5-fold higher risk for ADHD. Stratified analysis revealed a 2.1-fold higher risk for ADHD among females with LCPD than among females without LCPD. The risk for depression was 1.3-fold higher, and more pronounced among females with LCPD. Patients with LCPD had a slightly higher mortality risk with higher risk for death from suicide and cardiovascular causes.

Patients with a history of LCPD reported a lower health-related quality of life and were more physically active than the Swedish population norm. 28% of 116 patients were likely to have ADHD or had already been diagnosed with ADHD.

Both vascular and blood diseases could be present even in childhood and could, in combination with hyperactive behavior pattern and a high physical activity level, contribute to the etiology of LCPD. The lower health-related quality of life and higher risk for depression might reflect the mental burden of LCPD. Patients with LCPD have a higher mortality risk with higher risk for death from suicide and cardiovascular causes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 979
Keyword
Legg-Calvé-Perthes disease, hypertension, ischemic heart disease, coagulation, risk factors, etiology, injury, quality of life, EQ-5D, IPAQ, physical activity, ADHD, ASRS, depression, mortality
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-219158 (URN)978-91-554-8899-4 (ISBN)
Public defence
2014-04-25, Grönwallsalen, Akademiska Sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2014-04-03 Created: 2014-02-24 Last updated: 2014-04-29Bibliographically approved

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