An Evaluation of Various Methods of Treatment for Legg???Calv?????Perthes Disease

Wang, Li; Bowen, J. Richard; Puniak, M. A.; Guille, James T.; Glutting, Joe

doi:10.1097/00003086-199505000-00029

Cited by 20 publications

(30 citation statements)

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“…These regimes used bed rest or immobilization on a frame with or without abduction, casts, or various periods of traction. Eventually, these conservative regimes were abandoned due to the questioned long-term efficacy, disuse muscle atrophy, osteopenia, high hospital costs, and supposed negative social and psychological effects [17,[19][20][21][22][23]. Most other literature describing bed rest and traction in abduction treatment used it as part of a treatment regime including other treatments, e.g., a short period of abduction in traction to overcome hip irritability and regain range of motion followed by another type of (non)operative containment method [15,47,[50][51][52][53][54][55][56].…”

Section: Discussionmentioning

confidence: 99%

“…This would prevent mechanical deformation of the femoral head and, hence, early osteoarthritis changes. This type of containment treatment was abandoned for various reasons, including questioned long-term efficacy, muscle disuse atrophy, high hospital costs and negative psychosocial effects related to prolonged treatment time [17,[19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Wagenaar

Maathuis

Erve

2011

Journal of Children's Orthopaedics

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Purpose Compare conservative and operative treatment in the most severely affected Legg-Perthes disease patients. Methods 29 patients (14 conservative and 15 operative) with 32 affected hips (16 conservative and 16 operative) were evaluated, all Catterall 3 or 4. The conservative group, with a median age-at-onset of 4.8 (range, 2.5-9.5) years, was treated by a rigorous regime of traction in abduction for an average of two years. Follow-up was performed at a median of 28.6 (range, 17.4-31.6) years with a median patient age of 34.1 (range, 19.9-39.3) years. The operative group, with a median age-at-onset of 4.7 (range, 2.0-7.8) years, was treated by femoral varus derotation osteotomy. Follow-up was performed at a median of 14 (range, 8-21.4) years, with a median patient age of 20.7 (range, 12.8-28) years. Results Median age-at-onset (P = 0.16) and Catterall classification (P = 0.29) were comparable. No differences could be found for the Stulberg classification (P = 0.83), functional parameters (Harris Hip score and Merle d'Aubigné and Postel), and leg-length differences. Career choices were similar for both patient groups, as well.Conclusions Given methodological issues, femoral varus derotation osteotomy did not show apparent better results than the conservative containment regime in Catterall 3 and 4 patients with a median age-at-onset around 4.8 years. This result is fairly similar to recent literature suggesting a conservative approach in most severely affected patients with a young age-at-onset. However, based on unacceptable socioeconomic issues, the conservative regime evaluated in the present study cannot be justified, nowadays.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Wagenaar

Maathuis

Erve

2011

Journal of Children's Orthopaedics

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“…LCP is a typical form of avascular necrosis of the femoral epiphysis ossification center which occurs more often among boys (4:1 to 5:1) between 2 and 12 years old [7]. Treatment consists of keeping the epiphysis in the acetabulum until re-ossification is complete.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment consists of keeping the epiphysis in the acetabulum until re-ossification is complete. This is achieved with bilateral orthesis, holding the hips abducted 45°and internally rotated (5-10°) [7]. After 6 weeks of immobilization, the orthesis is removed but the patient remains in bed for 2 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Immobilization and hypercalciuria in children

et al. 2006

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Intermediate-term immobilization may lead to an increase in serum and urinary calcium. In order to test this hypothesis, we evaluated 46 children, 21 with Legg-Calvé-Perthes disease (LCP; 7.2+/-1.8 years old) and 25 with developmental dysplasia of the hip joint (DDH; 10+/-5 months of age), submitted to immobilization for up to 16 weeks. These two conditions require intermediate-term immobilization as treatment modality, and no studies evaluating calcium metabolism in these groups of patients have been conducted. In LCP patients, blood and 24-h urine samples were obtained before the beginning of treatment and after 1, 6, 8, 14 and 16 weeks of immobilization, while in DDH patients, blood and spot urine samples were collected before treatment and after 6 and 14 weeks of treatment. Urinary calcium, creatinine, potassium and sodium as well as serum calcium, phosphorus, parathyroid hormone, creatinine and alkaline phosphatase were determined in those samples. Renal ultrasound was performed before and after treatment. A mean increase of 2.3 times baseline values of urinary calcium was observed in 40% of previously normocalciuric LCP patients after only 1 week of immobilization. Among the DDH children, who had never previously ambulated, there was no significant variation in the urinary calcium excretion. None of the serum parameters changed in either group throughout the study. Urinary stones were not evidenced by renal ultrasound. Therefore, the present data suggested that intermediate-term immobilization led to a transient increase in urinary calcium in 40% of LCP patients. Complications such as urinary stones were not observed. In conclusion, this modality of treatment does not impose an increased risk of urinary stone formation in LCP and DDH patients.

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Osteochondrosis or Epiphysitis and Other Miscellaneous Affections

Canale¹

2008

Campbell's Operative Orthopaedics

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An Evaluation of Various Methods of Treatment for Legg???Calv?????Perthes Disease

Cited by 20 publications

References 0 publications

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Immobilization and hypercalciuria in children

Osteochondrosis or Epiphysitis and Other Miscellaneous Affections

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