Unravelling the Decline: A systematic review of incidence trends and contributing factors in Perthes disease

Background: Perthes disease, also known as Legg-Calvé-Perthes disease (LCPD), is a paediatric orthopaedic condition that compromises the blood flow to the hip joint causing avascular necrosis of the femoral head affecting the range of motion of the joint. Objective: This systematic review aims to explore the aetiologies underlying Perthes disease and examine recent incidence trends to assess potential links between incidence rates and specific causative factors. Method: This review was conducted systematically in accordance with PRISMA guidelines, utilising databases including PubMed, Scopus, Google Scholar, and Cochrane. Filters included English-language articles published within the last 10 years and relevant to the topic. The screening process further involved the removal of duplicates and evaluation of abstract relevance. Out of 1189 articles initially identified, 23 met the inclusion criteria and were selected for final analysis. Results: The studies analysed revealed a notable decline in the incidence of LCPD, which appeared to correlate with reductions in maternal smoking, improved breastfeeding practices, enhanced perinatal care, decreased exposure to environmental toxins, and shifts in socioeconomic conditions. Additionally, associations were identified between LCPD and various categories of aetiological factors, including genetic and biochemical markers, birth and perinatal influences such as obesity and metabolic disorders, lifestyle factors, and certain medication-related causes. Conclusion: The declining incidence of Perthes disease appears multifactorial with strong correlations to positive changes economically and environmentally.