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Legg-Calvé-Perthes Disease – Is it just the hip?: Epidemiological, Clinical and Psychosocial Studies with special focus on Etiology
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
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 [en]
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: urn:nbn:se:uu:diva-219158ISBN: 978-91-554-8899-4 (print)OAI: oai:DiVA.org:uu-219158DiVA: diva2:704027
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
List of papers
1. Legg-Calve-Perthes Disease and Risks for Cardiovascular Diseases and Blood Diseases
Open this publication in new window or tab >>Legg-Calve-Perthes Disease and Risks for Cardiovascular Diseases and Blood Diseases
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2010 (English)In: Pediatrics, ISSN 0031-4005, Vol. 125, no 6, E1308-E1315 p.Article in journal (Refereed) Published
Keyword
Legg-Calve-Perthes disease, hypertension, ischemic heart disease, coagulation, risk factors
National Category
Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-136077 (URN)10.1542/peds.2009-2935 (DOI)000278268600033 ()20439602 (PubMedID)
Note

Erratum in: Pediatrics, vol. 132, No. 1, July 1, 2013 pp. 186 -187, doi: 10.1542/peds.2013-0972

Available from: 2010-12-10 Created: 2010-12-09 Last updated: 2014-04-03Bibliographically approved
2. Legg-Calve-Perthes disease and the risk of injuries requiring hospitalization A register study involving 2579 patients
Open this publication in new window or tab >>Legg-Calve-Perthes disease and the risk of injuries requiring hospitalization A register study involving 2579 patients
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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..

National Category
Orthopedics
Identifiers
urn:nbn:se:uu:diva-190317 (URN)10.3109/17453674.2012.736167 (DOI)000311679900005 ()
Available from: 2013-01-10 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
3. Legg-Calvé-Perthes Disease: Quality of Life, Physical Activity, and Behavior Pattern
Open this publication in new window or tab >>Legg-Calvé-Perthes Disease: Quality of Life, Physical Activity, and Behavior Pattern
2014 (English)In: Journal of Pediatric Orthopaedics, ISSN 0271-6798, E-ISSN 1539-2570, Vol. 34, no 5, 514-521 p.Article in journal (Refereed) Published
Abstract [en]

Background: Legg-Calve-Perthes disease (LCPD) is a disease in children leading to deformation of the femoral head and can be a promoter for early dysfunction of the hip and early osteoarthritis of the hip. The study of health-related quality of life, physical activity, and behavior patterns in patients with LCPD can reveal its consequences later in life and also contribute to a better understanding of the etiology of the disease.

Patients and Methods: We identified 145 patients with LCPD diagnosed and treated at Uppsala University Hospital between 1978 and 1995. A total of 116 patients answered questionnaires regarding health-related quality of life (EQ-5D-3L), physical activity [International Physical Activity Questionnaire (IPAQ)], and hyperactive/inattentive behavior pattern [ADHD self-reporting symptom checklist (ASRS v1.1)] by interview. Patients were asked to report on fractures or soft-tissue injuries that required medical care. Medical charts were reviewed to determine age at onset of LCPD and treatment received.

Results: Patients with LCPD had significantly lower EQ-5D-3L and EQ VAS scores than the Swedish general population in all age groups. A total of 28% of our patient group had ASRS scores indicating they are likely or highly likely to have an ADHD diagnosis. A lower EQ-5D-3L score was significantly correlated with a higher total ASRS v1.1 score (=-0.309**). Over 90% of our patient group was physically active on a moderate or high level, despite 52% reporting either some or severe problems with pain according to the EQ-5D-3L questionnaire. Patients with high ASRS v1.1 scores (>16) had a significantly higher incidence of soft-tissue injuries than those with lower ASRS v1.1 scores.

Conclusion: The consequence of LCPD in adulthood was expressed in a lower quality of life compared with the Swedish general population. Despite this, the patients in our study reported a higher level of physical activity than the general population. A tendency toward hyperactive behavior pattern and high physical activity level may be present even in childhood and could contribute to the etiology of LCPD.

Level of Evidence: A retrospective study, level II.

Keyword
LCPD, quality of life, physical activity, ADHD, injury
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-219157 (URN)10.1097/BPO.0000000000000157 (DOI)000337745800009 ()
Available from: 2014-03-09 Created: 2014-02-24 Last updated: 2017-12-05Bibliographically approved
4. Legg-Calvé-Perthes disease and the risk of ADHD, depression and mortality: a register study involving 4057 individuals
Open this publication in new window or tab >>Legg-Calvé-Perthes disease and the risk of ADHD, depression and mortality: a register study involving 4057 individuals
2014 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 85, no 5, 501-505 p.Article in journal (Refereed) Published
Abstract [en]

Background and purpose Hyperactive behavior pattern (such as ADHD) is proposed to be present in individuals with LCPD. We investigated whether individuals with LCPD have a higher risk for ADHD, depression and mortality.

Subjects and methods We identified 4057 individuals with LCPD in Sweden during the period 1964-2011. 40570 individuals without LCPD were randomly selected from the Swedish general population and matched by year of birth, sex and region (control group). We used Cox proportional hazard regression to estimate the relative risks.

Results Compared to the control group, individuals with LCPD had a raised hazard ratio (HR) of 1.5 (95% CI 1.2-1.9) for ADHD. The risks were higher for female (HR=2.1, CI: 1.3-3.5) than for male individuals (HR=1.4, CI: 1.1-1.8). Individuals with LCPD had a modestly higher hazard ratio for depression (HR=1.3, CI: 1.1-1.5) than the control group. Furthermore, individuals with LCPD had a slightly higher mortality risk than the control group (HR=1.2, CI: 1.0-1.4)

Interpretation Individuals with LCPD have a higher risk for ADHD. Hyperactivity could expose the femoral head to higher mechanical stress and contribute to the etiology of LCPD. The higher risk for depression might be due to the burden of LCPD itself or could reflect neurobehavioral aspects of ADHD changing into depression later in life. Individuals with LCPD have a higher mortality risk with higher risk of committing suicide and a slightly higher risk of dying of vascular diseases.

Keyword
LCPD, ADHD Depression, Mortality, risk, Epidemiology
National Category
Orthopedics
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-219687 (URN)10.3109/17453674.2014.939015 (DOI)000342732200009 ()
Available from: 2014-03-09 Created: 2014-03-04 Last updated: 2017-12-05Bibliographically approved

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