Systematic review and meta-analysis of the efficacy of hip distraction in Legg-Calve-Perthes disease

Legg-Calve-Perthes disease (LCPD) is a common disease, with multiple treatment options, including hip distraction (HD), which is considered a relatively promising new modality. The main objective of the present study is to perform a systematic review and meta-analysis of the literature to determine if HD is a beneficial method for treating LCPD. A systematic review of existing literature was conducted. After screening for eligibility, clinical and radiographic outcomes were extracted. A meta-analysis of the extracted data was undertaken. All English full-text reports studying HD in LCPD patients aged 18 or less between 1990 and 2021 were considered eligible. A total of 65 full-text articles were assessed for eligibility. Clinical and radiographic outcomes were extracted. A meta-analysis of the extracted data was undertaken. Seventeen studies were included, with 259 patients diagnosed with LCPD. There were significant changes in abduction [mean = 20.97°, 95% confidence interval (CI): 17.39, 24.55, I2 = 0%], flexion (mean = 24.48°, 95% CI: 19.47, 29.50, I2 = 20%), and internal rotation (mean = 12.24°, 95% CI: 8.06, 20.42, I2 = 71%). The mean difference between pre-operative and post-operative pain scores was significant ( P < 0.05) (mean 2.86, 95% CI: 2.5, 3.21). In terms of radiological parameters, the epiphyseal index indicated significant increases after distraction among the included studies (mean = 4.58, 95% CI: 0.05, 9.11, I2 = 89%). The current literature supports using HD among patients with LCPD, as it showed satisfactory outcomes in hip range of motion, pain, and radiographic parameters. Further focused research is warranted in this field to demonstrate the efficacy of HD.