Tony Herring & 50 years of contemplating Legg-Calvé-Perthes

This week, I talk with a true legend in Legg-Calvé-Perthes. Dr Tony Herring from Texas Scottish Rite for Children in Dallas Dr. Herring has had an illustrious career dedicated to helping children with all sorts of musculoskeletal problems. He developed a particular interest in Legg-Calvé-Perthes. Although he has published many articles on the subject, in 2004, he was the lead author in a study that is considered by many to be the landmark study in the understanding and treatment algorithm for patients with this condition. We talk about how he formed a study group in the 1980s, the challenges of putting together such a large multi-center study in an era before e-mail or even fax machines were commonplace. We discuss the development of the lateral pillar classification, commonly known as the Herring classification, and how it has maintained its value as the most important prognostic factor for this condition. He explained how he has been able to review all of the images from the original study by digitizing them and, with the advantage of hindsight, has found new and unexpected changes in these radiographs. We discuss treatment indications and the variability inherent to any surgical intervention. We talk about the role of perfusion MRI in dictating the vascular status of the proximal femoral epiphysis and about future research directions.