Long-Term Prognosis of Legg-Calvé-Perthes Disease

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

“…Even though radiologic results appear to worsen significantly when LCPD patients reach their 40s, the prognosis of untreated patients remains unknown and difficult to predict. In follow-up studies beyond 40 years, reporting patients aged 50-60 years old and older, degenerative disease usually develops in the majority of patients [47]. No convincing reports are available on the long-term outcome of operative treatment on osteoarthritis [47].…”

“…These include large differences in-or lack of-information on classification methods, inclusion criteria, age groups, treatment selection, evaluation criteria, incomplete data and other factors [9,13,45,46]. Furthermore, few reports describe the true natural history of the disease [9,41,47] and even fewer prospective studies [13,34,48] are available. This makes drawing conclusions difficult, if not impossible, and any statements that follow should be read with these remarks in mind.…”

“…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].…”

“…Osteoarthritis signs were recorded in 37% of Catterall 3 and 70% of Catterall 4 patients aged between 30 and 40 years old. Yrjönen [47] performed a meta-analysis reviewing the long-term prognosis of LCPD with and without treatment. Even though radiologic results appear to worsen significantly when LCPD patients reach their 40s, the prognosis of untreated patients remains unknown and difficult to predict.…”

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

“…These patients may develop a saddle-shaped subluxating femoral head that cannot be contained in the acetabulum. Since conservative treatment does not change the shape of the femoral head or affect joint congruency [2][3][4][5][6][7][8][9][10], different surgical treatment options have been proposed, including varus osteotomy (which may increase the incongruency) and valgus osteotomy (which may succeed in unloading the deformed part but may increase the subluxation without influencing the basic avascular process) [11][12][13]. Acetabular lateral shelf, Salter, Chiari, and triple osteotomies are considered salvage procedures at this age group that aim to reorient or increase the size of the acetabulum and produce more support to the femoral head [14][15][16][17][18].…”