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

Abstract

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.

Outcome of Varus Derotation Osteotomy for Containment of Femoral Head in Advanced Perthes Disease

“…Similar findings were observed in the studies done by the various researchers from different countries. 2,15 In this study involvement of hip, onset and character of pain of all the subjects in both groups were almost similar and there were no statistically significant differences. But statistically significant difference was observed in duration of pain in between the groups.…”

Does Prolonged Weight Relief Increase the Chances of a Favourable Outcome After Containment for Perthes Disease?

“…15 Similarly, a few clinical studies have endorsed this view. 3,4,16,17 The impression that weight-bearing in the early stages of LCPD predisposes to deformation of the femoral head has been recently supported by the findings in a novel MRI study. 18 The study demonstrated flattening and widening of the epiphysis as soon as children with LCPD who were early in the course of the disease bore weight on the limb.…”

“…However, experimental studies have shown that weight relief does have a definite protective effect on the shape of the femoral head following ischemic necrosis 15. Similarly, a few clinical studies have endorsed this view 3,4,16,17. The impression that weight-bearing in the early stages of LCPD predisposes to deformation of the femoral head has been recently supported by the findings in a novel MRI study 18.…”

Association of MTHFR and TNF-α genes polymorphisms with susceptibility to Legg-Calve-Perthes disease in Iranian children: A case-control study

“…2 Although the extensive literature pertaining to LCPD, there is still a gap in our knowledge about its risk factors, etiology and preventive strategies. 1,3,4 LCPD is a multifactorial disorder and apparently both genetic and environmental factors have been implicated in its etiopathogenic mechanisms. 2 However, a few familial cases with autosomal dominant inheritance due to mutations in a single gene such as COL2A1 have been reported.…”