Treatment for Legg-Perthes Disease with the Newington Ambulation-Abduction Brace

Curtis, Burr H.; Gunther, Stephen F.; Gossling, Harry R.; Paul, Siegfried W.

doi:10.2106/00004623-197456060-00003

Cited by 33 publications

(15 citation statements)

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“…5 Containment of the vulnerable and biologically plastic femoral head in the acetabulum early in the disease was believed to result in a more spherical head during the repair process, thereby resulting in a more congruent joint. 6 Non-operative containment treatment has involved different braces, [7][8][9][10][11] whereas surgical containment includes varus osteotomy of the proximal femur, [12][13][14] or various types of innominate osteotomy [15][16][17] to redirect the acetabulum and thereby improve femoral head cover. Most studies on treatment are retrospective, with a relatively small number of patients and without a control group.…”

mentioning

confidence: 99%

Prognostic factors and outcome of treatment in Perthes’ disease

Wiig¹,

Terjesen

Svenningsen

2008

The Journal of Bone and Joint Surgery. British volume

182

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This nationwide prospective study was designed to determine prognostic factors and evaluate the outcome of different treatments of Perthes' disease. A total of 28 hospitals in Norway were instructed to report all new cases of Perthes' disease over a period of five years and 425 patients were reported and followed for five years. Of these, 368 with unilateral disease were included in the present study. The hips were classified radiologically according to a modified two-group Catterall classification and the lateral pillar classification. A total of 358 patients (97%) attended the five-year follow-up, when a modified three-group Stulberg classification was used as a radiological outcome measure. For patients over six years of age at diagnosis and with more than 50% necrosis of the femoral head (152 patients), the surgeons at the different hospitals had chosen one of three methods of treatment: physiotherapy (55 patients), the Scottish Rite abduction orthosis (26), and proximal femoral varus osteotomy (71). Of these hips, 146 (96%) were available for the five-year follow-up. The strongest predictor of outcome was femoral head involvement of more or less than 50% (odds ratio (OR) = 7.76, 95% confidence interval (CI) 2.82 to 21.37), followed by age at diagnosis (OR = 0.98, 95% CI 0.92 to 0.99) and the lateral pillar classification (OR = 0.62, 95% CI 0.40 to 0.98). In children over six years at diagnosis with more than 50% of femoral head necrosis, proximal femoral varus osteotomy gave a significantly better outcome than orthosis (p = 0.001) or physiotherapy (p = 0.001). There was no significant difference between the physiotherapy and orthosis groups (p = 0.36), and we found no difference in outcome after any of the treatments in children under six years (p = 0.73). We recommend proximal femoral varus osteotomy in children aged six years and over at the time of diagnosis with hips having more than 50% femoral head necrosis. The abduction orthosis should be abandoned in Perthes' disease.

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mentioning

confidence: 99%

Prognostic factors and outcome of treatment in Perthes’ disease

Wiig¹,

Terjesen

Svenningsen

2008

The Journal of Bone and Joint Surgery. British volume

182

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show abstract

“…Furthermore, treatment may attempt to prevent hip joint deformity by containment of the femoral head in the acetabulum during the active phases. The most widely used methods of containing the femoral head in the acetabulum are abduction orthosis (Curtis et al 1974, Bobechko 1974, Purvis et al 1980, Martinez et al 1992 and femoral or pelvic osteotomies (Axer et al 1980, Heikkinen et al 1976, Sponseller et al 1988, Paterson et al 1991, Salter 1984. The operative containment treatment has consisted of varus osteotomy of the proximal part of the femur, which centers the femoral head more deeply within the acetabulum.…”

Section: Treatmentmentioning

confidence: 99%

“…Complications included muscular atrophy, osteopenia, shortening of the involved extremity, loss of thoracal kyphosis, and urinary caliculi. (Harrison and Menon 1966, Harrison et al 1969, Curtis et al 1974, Brotherton and Mc Kibbin 1977, Martinez et al 1992. Fortunately, long-time recumbency treatment is currently considered as malpractice and abandoned altogether.…”

Section: Non-containment Treatmentmentioning

confidence: 99%

“…Varying results have been reported with the Scottish Rite orthosis. Curtis et al (1974) reported 84% good or fair, and 16% poor results, and Herring et al (2004) also had quite good outcome with 52% of the hips in Stulberg classes I-II, 31% in Stulberg class III, and only 17% poor results in Stulberg class IV-V. We found, however, that patients above 6.0 years at the time of diagnosis with hips with more than 50% femoral head necrosis obtained inferior results, with 18% of the patients in Stulberg classes I-II, 37% in Stulberg class III, and 44% of the patients in Stulberg class IV-V. Thus, our results in this age group with femoral head necrosis more than 50% were worse than those of Martinez et al (1992) and Meehan et al (1992) who had 33% and 21% poor Stulberg results, respectively.…”

Section: Containment Treatmentmentioning

confidence: 99%

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Perthes' disease in Norway

Wiig

2009

Acta Orthopaedica

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“…However, the limitations of this examination are that the sizes of the osteochondral femoral head and acetabulum, their shapes and their relationships to one another cannot be accurately assessed; thus the type and severity of the lesion may be incompletely appreciated. It has been shown that containment treatment of the femoral head gives the best opportunity for the development of a spherical head at the end of the regeneration process (Axer 1965 Axer et al 1973, Curtis et al 1974, Brotherton & McKibbin 1977, Salter et al 1977). The problem is to assess the degree of rotation of the femur (or pelvis) required to achieve adequate containment.…”

mentioning

confidence: 99%