A child’s hip joint is vulnerable to an interrupted blood supply in a way that an adult’s is not, due to the limited blood supply across the cartilaginous physis (growth plate). When the blood supply to a child’s proximal femur is interrupted due to trauma or disease, children are at risk of avascular necrosis (AVN), or death, of the bone tissue in the femoral head (the secondary ossification centre). AVN of the femoral head can lead to a permanent collapse of the proximal femur, leaving the child at risk of needing a hip replacement in the short or medium term. Having a hip replacement in childhood has very severe implications for the child’s future.
There are four main conditions/scenarios associated with hip AVN. The first is Legg-Calve-Perthes disease (known as Perthes disease). Another scenario in which hip AVN is common is in children being treated with high-dose steroids, particularly in children undergoing cancer treatment. Hip AVN can also occur after a trauma to the hip joint, including after a slipped capital femoral epiphysis (SCFE). Finally, hip AVN is common in children with sickle cell disease.
We will apply machine learning and advanced statistical methods to MR images taken at the time of diagnosis of Perthes disease or JIN. Using an automated system of shape, compositional and spatial analyses of the hip, combined with child specific parameters, we will develop a prognostic model to predict femoral head collapse, and inform on the optimal intervention to prevent future pain and early joint replacement.