A Comparison of the Effectiveness of Surgical and Nonsurgical Treatment of Legg-Calve-Perthes Disease: A Review of the Literature

Musculoskeletal Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.
Advances in orthopedics 08/2012; 2012(2):490806. DOI: 10.1155/2012/490806
Source: PubMed


Legg-Calve-Perthes disease (LCPD) is a degenerative condition of the hip joint characterised by idiopathic avascular necrosis of the femoral head. Loss of bone mass causes a degree of collapse of the joint and may result in deformity of the ball of the femur and the surface of the hip socket. A reduction in hip joint range of motion, alternation in growth of femoral head, and associated pain are most important problems associated with this disease. Various treatment methods are currently in use and aim to increase containment of the femoral head within the acetabulum, redistribute loading patterns applied to the femoral head, and to decrease the final deformities associated with this condition. These treatments depend on a variety of underlying factors and the aim of this paper was to determine appropriate pathways for treatment and the evidence of treatment method success. A review of the relevant literature was carried out in a variety of data bases including PubMed and ISI Web of Knowledge, and Gale between 1950 and 2011. Research results were categorised depending on the identified treatment method. The success of each treatment pathway was assessed and reasons for the pathway selected were grouped by the age of disease onset, follow-up period, and the final outcome. Evidence relating to the effectiveness of the treatment method used was conflicting. Different methods of screening and follow-up periods were employed in each study which used subjects of varying ages. Minimal evidence of sufficient quality exists in the literature to determine the most appropriate treatment of Legg-Calve-Perthes disease. Research provides some evidence to suggest that nontreatment may be as effective as orthotic or surgical intervention. More research is required to determine the effectiveness of orthotic and surgical treatment.

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Available from: Mohammad Karimi, Dec 15, 2014
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    ABSTRACT: Background: Legg-Calve-Perthes' Disease (LCPD) is an idiopathic avascular necrosis of the femoral head. It affects children between four and 10 years. Male : female ratio of 4:1. The main aim of treatment is to get an acceptable containment of a spherical head with good range of motion. Ideal way of treatment remains controversial. Objectives: To study patterns of presentations and outcome of management of patients with LCPD treated at Soba University Hospital. Materials and Methods: Records of patients with LCPD who were treated at Soba University Hospital between 2005 and 2013 were reviewed. There were 43 patients (46 hips). Their patterns of presentation, follow up notes and imaging as well as clinical and radiological outcome were reviewed. Results: There were 43 patients 29 Males and 14 females (2:1) with 46 hips. Their ages ranged between 4 and 12 years (mean 7.7). 74.4% of patients were from low socioeconomic strata of the society. 9.3% of patients had family history and 58.1% had history of trauma. Painless limp was the presenting complaint in 88.4%. Herring lateral pillar classification was used; 43.5%) group A, 37.0% B, 13.0% B/C and 6.5% C. Thirty four hips (73.9%) had conservative treatment using Ischial Weight Bearing Calliper and physiotherapy in Lotus (Fagir) sitting Position and 12 hips (26.1%) had surgical treatment. Thirty one hips (67.4%) of those who were treated conservatively healed with Stulberg I or II, while 7 hips (58%) of those who underwent surgery with Stulberg I or II. Most of patients who presented at age less than 6 years healed with Stulberg I or II. Conclusion: LCPD affects children of low class. Prognosis is generally good when the age at onset less than 6 years. Herring's lateral pillar classification is a reliable method of classification. Conservative treatment using Ischial Weight Bearing Calliper and physiotherapy in Lotus (Fagir) sitting Position has good outcome.
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