Miriam G Wadström: Growing up with pediatric hip disease– a companion for life: Exploring the multifaceted experiences throughout life, with special attention to Legg-Calvé Perthes disease

Abstract

Pediatric hip diseases such as developmental dysplasia of the hip, Legg-Calvé-Perthes disease, and slipped capital femoral epiphysis can lead to lasting hip deformities and early-onset osteoarthritis. This thesis explores the long-term impacts of these conditions, combining patient experiences with large-scale data.

Study I used data from the Swedish Pediatric Orthopedic Quality Register to examine the incidence, demographics, and risk factors for containment surgery in patients with unilateral Legg-Calvé-Perthes disease. 309 patients registered between 2015 and 2024. The study found a national yearly incidence of 4.2 per 100,000 children aged 2–12 years, somewhat lower than previously reported in Sweden. The disease was more common in boys (77%), with an average diagnosis age of 6 years. Notably, 30% of patients were overweight or obese at diagnosis, increasing to around 40% at the 2-year follow-up. The study also found that older age, a positive Trendelenburg sign, and limited hip abduction at diagnosis increased the likelihood of surgical intervention.

Study II focused on the long-term impact of Legg-Calvé-Perthes disease as experienced by patients through qualitative interviews. Themes that emerged included self-reinvention, concerns about future health, surgical interventions, and challenges with physical activities leading to sedentary lifestyles. The study also highlighted patients' sense of disconnection during the transition from pediatric to adult care and emphasized the need for continuous, age-appropriate information and structured healthcare transitions.

Study III explored whether individuals with a history of Legg-Calvé-Perthes disease or slipped capital femoral epiphysis are at increased risk of receiving prescriptions for pain or antidepressant medications in adulthood. The study, which included 1,292 Legg-Calvé-Perthes disease patients and 1,613 slipped capital femoral epiphysis patients, found a higher risk of analgesic prescriptions in both groups compared to matched controls. Additionally, slipped capital femoral epiphysis patients had a slightly higher risk of antidepressant prescriptions. The findings underscore the need for long-term pain management and health support.

Study IV investigated mortality risks after total hip arthroplasty in patients with a history of pediatric hip disease. Among 4,043 patients identified from the Swedish Hip Arthroplasty Register, the study found no increased 90-day mortality risk compared to the general population. These patients’ overall mortality risk was lower, suggesting that total hip arthroplasty does not increase mortality risks despite their pre-existing conditions.

In conclusion, this thesis provides a comprehensive view of the long-term impacts of pediatric hip diseases, highlighting the need for improved, continuous, and age-appropriate care strategies to enhance patient outcomes.