Letters to the Editor   |    
Legg-Calvé-Perthes Disease: The Effect of Treatment on Outcome
David G. Little, MMBS, FRACS(Orth), PhD1
1 Department of OrthopaedicsThe Children's Hospital at WestmeadLocked Bag 4001Westmead NSW 2145Sydney, Australiadavidl3@chw.edu.au
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The author did not receive grants or outside funding in support of his research or preparation of this work. The author received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Novartis Pharmaceuticals). In addition, a commercial entity (Novartis Pharmaceuticals) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 May 01;87(5):1164-1165
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To The Editor:The paper "Legg-Calvé-Perthes Disease. Part II: Prospective Multicenter Study of the Effect of Treatment on Outcome" (2004;86:2121-34), by Herring et al., is a landmark in pediatric orthopaedics. Dr. Herring et al. and the Legg-Perthes Study Group are to be congratulated on accumulating so many data in a prospective long-term study.The authors have performed an expansive analysis. Sample-size constraints led the authors to combine groups and to conclude that operative treatment was better than nonoperative treatment. However, if we compare bracing and surgical treatment (containment) with range-of-motion exercises and no treatment (noncontainment), the difference is highly significant in favor of containment (chi-square analysis; p < 0.01). When operative treatment is compared with bracing, no significant difference is observed, although the sample sizes are roughly equivalent (129 in the bracing group and 119 in the operative treatment group). The authors appear to have been selective in their comparisons. On the basis of logistic regression and Wald chi-square tests, the most important factors were classification and age, not treatment.
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