0
Scientific Article   |    
Prospective Reevaluation of the Association Between Thrombotic Diathesis and Legg-Perthes Disease
M. Timothy Hresko, MD; Patricia A. McDougall, MD; Jed B. Gorlin, MD; Eleftherios C. Vamvakas, MD, PhD; James R. Kasser, MD; Ellis J. Neufeld, MD, PhD
View Disclosures and Other Information
Investigation performed at the Department of Orthopaedic Surgery and the Division of Hematology, Children's Hospital, Harvard Medical School, Boston, Massachusetts

M. Timothy Hresko, MD
James R. Kasser, MD
Ellis J. Neufeld, MD, PhD
Department of Orthopaedic Surgery (M.T.H. and J.R.K.) and Division of Hematology (E.J.N.), Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail address for M.T. Hresko: timothy.hresko@tch.harvard.edu. E-mail address for J.R. Kasser: james.kasser@tch.harvard.edu. E-mail address for E.J. Neufeld: ellis.neufeld@tch.harvard.edu

Patricia A. McDougall, MD
Department of Orthopaedic Surgery, Prevea Clinic, 900 South Webster Avenue, Green Bay, WI 54301

Jed B. Gorlin, MD
Memorial Blood Centers of Minnesota, 2304 Park Avenue, Minneapolis, MN 55404. E-mail address: jed@mbcm.org

Eleftherios C. Vamvakas, MD, PhD
New York University Medical Center Blood Bank, RRG-17, 400 East 34th Street, New York, NY 10016. E-mail address: stephen.vamvakas@med.nyu. edu

In support of the research or preparation of this manuscript, E.J. Neufeld received grant K24HL04184 from the National Institutes of Health. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated

J Bone Joint Surg Am, 2002 Sep 01;84(9):1613-1618
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Legg-Perthes disease is associated with ischemia of the capital femoral epiphysis in children. Thrombophilia has been implicated as a potential cause of the condition, and screening of patients with Legg-Perthes disease for thrombophilia has been recommended. We analyzed the value of screening for inherited thrombophilia in patients with Legg-Perthes disease by examining the association between Legg-Perthes disease and abnormalities in the thrombotic pathway.

Methods: A random series of consecutive patients with Legg-Perthes disease were prospectively enrolled in this study. Assays for the detection of factor-V Leiden mutation and the plasma concentrations of protein C, protein S, antithrombin III, and lipoprotein (a) were performed on plasma samples from children with Legg-Perthes disease, and the results were compared with those for pooled plasma from normal controls. Plasma concentrations below the 95% midrange of the control values were classified as protein deficiencies. The estimated population frequency of each coagulation abnormality was compared with the proportion of the study group with the corresponding abnormality.

Results: The proportion of abnormalities observed in the study group did not differ from the estimated population frequency for protein C, protein S, antithrombin III, or factor-V Leiden mutation. A lipoprotein (a) level of >30 mg/dL (>1.07 µmol/L) was found in 16% of the study group.

Conclusions: Our data do not suggest that thrombotic diatheses due to deficiency of protein C, protein S, or antithrombin III or due to factor-V Leiden mutation are major causes of Legg-Perthes disease. The elevated levels of lipoprotein (a) in children with Legg-Perthes disease suggest that they may be at risk for atherosclerosis as adults.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    02/28/2014
    District of Columbia (DC) - Children's National Medical Center
    04/02/2014
    W. Virginia - Charleston Area Medical Center
    12/04/2013
    New York - Icahn School of Medicine at Mount Sinai
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina