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dc.contributor.authorNath Adulkasemen_US
dc.contributor.authorPhichayut Phinyoen_US
dc.contributor.authorPasin Tangadulraten_US
dc.contributor.authorJidapa Wongcharoenwatanaen_US
dc.contributor.authorThanase Ariyawatkulen_US
dc.contributor.authorChatupon Chotigavanichayaen_US
dc.contributor.authorKamolporn Kaewpornsawanen_US
dc.contributor.authorPerajit Eamsobhanaen_US
dc.description.abstractPurpose: There are several treatment modalities for Legg-Calvé-Perthes disease (LCPD), self-limiting, avascular osteonecrosis of the femoral head in children. Most treatments focus on containment of the weakened femoral head, but there is no consensus on the best modality for severe LCPD. Therefore, we compared the effectiveness of all treatment modalities for severe LCPD. Materials and methods: We searched the PubMed, Embase, and Scopus up until July 2021 for studies that investigated LCPD treatment effectiveness. A network meta-analysis was performed to examine the comparative effectiveness in terms of the ability to achieve radiographic spherical congruity of the hip joint after skeletal maturity. The risk ratio (RR) and 95% confidence interval (CI) of each treatment modality were estimated from both direct and indirect evidence. Treatment ranking was based on Surface Under the Cumulative Ranking curve (SUCRA). Results: A total of 857 studies were identified and 34 comparative studies with 3718 affected hips comparing seven different LCPD treatment modalities were included. Compared with symptomatic treatment, combined osteotomy was the most effective modality (RR = 1.47, 95% CI 0.90 to 2.42, SUCRA = 0.8), followed by femoral varus osteotomy (RR = 1.31, 95% CI 1.06 to 1.60, SUCRA = 0.7), and Salter innominate osteotomy (RR = 1.25, 95% CI 0.95 to 1.65, SUCRA = 0.6). Conclusions: Combined osteotomy is the most effective procedure in terms of improving the spherical congruity of the hip joint in severe LCPD patients. However, the superiority of operative treatments seems to be limited to patients older than eight years old.en_US
dc.titleComparative effectiveness of treatment modalities in severe Legg‑Calvé‑Perthes disease: Systematic review and network meta‑analysis of observational studiesen_US
article.title.sourcetitleInternational Orthopaedicsen_US
article.volume46en_US Hospitalen_US of Medicine, Chiang Mai Universityen_US Mai Universityen_US
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