ORCHID Study
Research type
Research Study
Full title
ORCHID STUDY - Outcome Research in CHildrens HIp Disease. A cohort study to determine the long term outcomes of paediatric hip disease.
IRAS ID
227197
Contact name
Daniel Perry
Contact email
Sponsor organisation
The University of Liverpool
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Research Summary
Significant hip deformities affect 1 in 500 children, cause significant pain, and often lead to a hip replacement in adolescence or early adulthood. There are no well-established treatments for these diseases, which is in part because there are no well-established outcome measures.There are several diseases that deform the hip throughout childhood. Affected children often undergo surgery in a bid to maximise the long-term function, and minimise the need for a hip replacement. The type of surgery required, and indeed whether surgery should be done at all, is controversial amongst surgeons world-wide. One of the important barriers to surgery is the lack of research that has compared the results of different surgical treatments, and this is at least in part a result of having no objective way to determine which hip is 'good', and which is 'bad' at the end of treatment.
We will develop a system to accurately measure the bones in the hip joint using X-ray images. By studying the X-rays and the clinical symptoms of people with two common hip diseases, both during and in later life, we will develop methods to predict likely outcomes of the disease, and to choose the most appropriate treatment.
Summary of Results
Aims
This project involved children affected by these diseases, along with adults who suffered from these diseases as children. We collected functional outcomes from those affected, and correlated the functional outcomes with radiographic outcomes. We will then sought to identify if early radiographs are able to predict both long-term functional outcomes and the rate of progression to osteoarthritis of the hip.Collaborators
Prof Tim Cootes, University of Manchester Dr Claudia Lindner, University of Manchester.
Prof Dan Perry, University of Liverpool.Key Outcomes:
In total, we collected patient reported outcomes for 266 children with Perthes’ Disease or Slipped Capital Femoral Epiphysis. In addition, we annotated thousands of radiographs of normal children, and those with disease.(1) Externally Validating New Functional Outcome Tools Through this we were able to demonstrate that a newly developed well-validated patient reported outcome, correlated well with legacy functional outcome tools, which are traditionally used by surgeons (Fig 1).
This has been published in the Bone and Joint Open - Use of the PROMIS Mobility score in assessing function in adolescents and adults previously affected by childhood hip disease - https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Furl6570.hra.nhs.uk%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbUh5lmQToAEIyw-2Fd2PznX8tN-2FZAVhDevdmM7XuJIfPY-2F4GsboJ1tNeFcprTYh9N-2BRAXm7nO1PUKM2gQzX04Hlp-2BYZ-2BHARmwcE7JiZv7uZjmh6yAF_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLaR6CZqNdoBGOjpWAl-2FTq1oJH8NvreHtZxhU2E-2BGaCmRhUGUMdvjdeQioSOpYvGNLT-2F0mEuLArq5WT5OQrwbhZuOHGCu6AMnEjspoBuh0EkHaLRBPUUtsEd8dAGkSjeoFw3iaUkqynO8sCo27nG0guOlT9gX9T-2BPT965pGQsjepA-3D-3D&data=04%7C01%7Capprovals%40hra.nhs.uk%7Cc5300f9bdd9d4aa785a708d9e5cda125%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637793493595095917%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=lmVchGD3nojPNfMHnQEWCmoGAjjg7XLqeW0ahQJVIws%3D&reserved=0(2) Correlating functional outcomes and radiographic severity.
Perthes’ disease constituted most of our cohort. For this disease surgeons determined the radiographic severity, using the Stulberg Grade from childhood radiographs. We were then able to correlate the functional score at follow-up, with the radiographic outcome, stratified by duration of follow-up.
This is currently submitted to the Bone and Joint Journal.(3) Automatically identifying Perthes’ Disease.
We went onto explore if machine vision is capable of detecting and identifying Perthes’ Disease. Using this technique we were able to develop a technique that reliably identified features of hip disease in children automatically using a computer.This used the principle of edge detection to automatically extract key features. With this, we achieved success with very high success rates in describing the variation in the data.
Through this, we have so far published one paper in Lecture Notes in Computer Science, and won the Best Clinical Poster Prize at the 2020 Bone and Research Society Meeting.
• Perthes Disease Classification Using Shape and Appearance Modelling https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Furl6570.hra.nhs.uk%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbXqhjxGs9JPY7XtTO7ml43sXOTI72ESEZVKQnTC3Ks7frw5XwVrtQNmCTn1mSUy82tNJOUewaXF8bBRA86dwQmg-3DDjkm_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLaR6CZqNdoBGOjpWAl-2FTq10eJnZmZBLwL5KxZ9RXu1VnGjQSuO7MKPon5Ewiqr1zrzBrS6UVpehK-2BlODfehi7z4jc3-2BIs4xkMjJRi2gAji-2B3tn-2FdJRHHgz4WbdBjJF3UsZyqR0ZR6-2B7kvyX9PwndZzVQYPCOUMkmY8NlSanw9MmA-3D-3D&data=04%7C01%7Capprovals%40hra.nhs.uk%7Cc5300f9bdd9d4aa785a708d9e5cda125%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637793493595095917%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=7siQQxTrHlFfAXrKPLMl%2BlKBAhwZDoepjH0eKGeGOgw%3D&reserved=0
• Landmark Localisation in Radiographs Using Weighted Heatmap Displacement Voting. 10.1007/978-3-030-11166-3_7 • Detecting Perthes Disease and Investigating the Effects of Aging on Hip Shape in Children. Bone Research Society Annual Meeting 2020. Best Clinical Poster Prize.
We are still to publish a final manuscript comparing automatic disease detection with human raters.Public Dissemination.
We maintain a website which details (open access) all of the studies related to this work - https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Furl6570.hra.nhs.uk%2Fls%2Fclick%3Fupn%3Dn6BR4TrpKIA6R-2FJC28yNaQUC-2F-2FcZ3J8DR9SCdt9gfoktfAS9F4f-2BjZUJl62Wz92K3-2C_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLaR6CZqNdoBGOjpWAl-2FTq1U2uKxBjJzOFyHMz2C9eQexYM-2Fd-2Be3zxHVqmZn5jJ0CCGIQUMFqTUx56Uz0UXWoq-2FhgHEsrysB-2FbcApDmhL6q-2BK8d-2FWv0rAtYDy6gFs8NgGWvIIjIZdMY8ToYXhc5ZvBgVAqMmptqrEYFKYssyp0Hxw-3D-3D&data=04%7C01%7Capprovals%40hra.nhs.uk%7Cc5300f9bdd9d4aa785a708d9e5cda125%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637793493595095917%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=iq7lyj4Ed%2F3bfZ0q%2FYRnUOCUp2uPe1FEUrD5%2BqQgoD0%3D&reserved=0
Studies are published Open Access.We have also produced an animation to explain our work to the public - https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Furl6570.hra.nhs.uk%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbeFnF6YL99Q6ugpqxx32tVtCixHCUHaYk7uXrfg1zSDrzGoS_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLaR6CZqNdoBGOjpWAl-2FTq1XVxReeBJN0alTXl-2FqlNhdjxO7quKHErAhRTpznaWe-2FMDfdZepSB7TnxhM-2B5ms4b87OEEA3vei2lpPTIEQ0cy8wUbcPeedJ0rphAHSuZNruwmy0U40Jw0N1h75q9S2eHKggBfAH2O-2FFdyV4GlkHSUNg-3D-3D&data=04%7C01%7Capprovals%40hra.nhs.uk%7Cc5300f9bdd9d4aa785a708d9e5cda125%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637793493595095917%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=zvDg6R%2Fso34fkvKCz3pKKZ0kMS%2Fc1VMiVjAYyOa5gO0%3D&reserved=0
Future Work
We have recently secured NHS X funding to develop the model, to use it for children with Cerebral Palsy. The hope of the future work is that the tool can be integrated into national CPIPs pathway – to maximise care for children with cerebral palsy.REC name
East of Scotland Research Ethics Service REC 2
REC reference
17/ES/0113
Date of REC Opinion
18 Aug 2017
REC opinion
Favourable Opinion