Arthrodiastasis in Perthes’ disease

Abstract

We have examined the effect of arthrodiastasis on the preservation of the femoral head in older children with Perthes' disease. We carried out a prospective trial in boys over the age of eight years and girls over seven years at the time of the onset of symptoms. The patients had minimal epiphyseal collapse and were compared with a conventionally treated, consecutive, historical control group. Arthrodiastasis was applied for approximately four months. The primary outcome measure was the extent of epiphyseal collapse at the end of the fragmentation phase. One of the 15 treated hips and nine of the 30 control hips showed a loss of height of 50% or more of the lateral epiphyseal column on the anteroposterior radiographs (Herring grade-C classification). On a Lauenstein view, one of the treated hips and 19 of the control hips showed at least a loss of height of 50% of the anterior epiphyseal column. The complications of arthrodiastasis included pin-site infection in most hips, transient joint stiffness in two, and breakage of a pin in two. The final outcome will be known when all the patients and the control group reach skeletal maturity.

Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calvé-Perthes disease: a prospective controlled trial

“…Several studies have evaluated the role of arthrodistraction in the treatment of Perthes' disease [12][13][14][15][16][17], but with discrete methodologies. Some authors included soft tissue release [16], whereas others used the non-articulated Ilizarov system [15].…”

“…Some authors included soft tissue release [16], whereas others used the non-articulated Ilizarov system [15]. Maxwell et al [12] applied a unilateral articulated external fixator in 15 hips and used a historical series as a control. The authors considered their results as preliminary, with numerous complications, but felt that the method might benefit patients with Perthes' disease [12].…”

“…More recently, there has been some evidence to suggest that distraction forces applied to the hip joint can offer mechanical protection to the femoral head and promote bone revascularisation [12][13][14][15][16][17]. Therefore, hip joint distraction may offer an alternative therapeutic option for patients with Legg-Calvé-Perthes disease (otherwise called Perthes' disease), as it represents an attractive link between mechanical and biological processes.…”

“…However, this treatment has not been widely accepted, as the literature does not show strong scientific evidence that it is more beneficial for the patient, when compared with traditional methods. Most of the series published to date indicate the benefit of hip distraction in Perthes' disease patients; but these studies are considered preliminary [12], or the series are too small to guarantee reliable conclusions [15][16][17].…”

Treatment of severe late-onset Perthes’ disease with soft tissue release and articulated hip distraction: Revisited at skeletal maturity

“…Joseph et al [1] recommended that treatment should be started before epiphyseal collapse had occurred, since the potential to remodel in the older age group children is limited. Maxwell et al [30] applied the articulated distractor to hips with minimal collapse in order to maintain epiphyseal height. They reported early results with preservation of epiphyseal height and arrest of epiphyseal collapse.…”