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The Treatment of Legg-Calve-Perthes Disease

By Herring, J. A.

VOL. 76-A, NO. 3, MARCH 1994, pp. 448-458

' Recommendations for Treatment

These guidelines for treatment are based on my clinical experience and my ten years of experience in working with members of a group involved in an ongoing multicenter prospective study of patients who have Legg-Calve-Perthes disease. At the time of writing, more than 300 hips  in that study have had complete healing of the femoral head. We have noted the effects of different treatment modalities, and we can compare the results obtained with each. However, the study must be completed before these findings can be used to validate treatment guidelines.

The goals of treatment are relief of symptoms, containment of the femoral head, and restoration of a range of motion. Treatment for the relief of symptoms includes the use of traction, at home or in the hospital, for periods ranging from one or two days to several weeks; partial weight-bearing with use of crutches in order to rest an inflamed, painful joint; and the use of anti-inflammatory medication. The goal of containment is to maintain the sphericity of the femoral head. This can  be achieved with use of traction and muscle releases to regain motion;
application of a brace with the hip in an abducted position, with or without control of internal rotation; and operative procedures, such as femoral varus osteotomy and Salter innominate osteotomy. A range of motion is regained or maintained through the use of traction, muscle releases, and exercises of the hip that has limited motion secondary to muscle spasm and
pain. A Petrie plaster cast is used occasionally. 

Because age remains a strong prognostic factor, the guidelines are presented according to the patient's age at the onset of the disease.

Patients Who Are Less Than Six Years Old 

Most studies have shown that 50 to 70 per cent of children in this age-group have a good result and only 9 to 30 per cent have a poor result.
Furthermore, the deformity of the femoral head in patients who have a poor result usually progresses over many years because of the disordered growth of the capital physis. There is no evidence that any form of treatment alters either the growth potential of the physis or the outcome. Therefore, it seems logical to assume that the purpose of treatment of these patients
is to alleviate the symptoms. The use of traction at home, the avoidance of  weight-bearing, and the administration of non-steroidal anti-inflammatory medications are the usual modalities of treatment and should be used only when symptoms are present. Most children in this age-group have mild symptoms of limited duration and need little active treatment.

Patients Who Are Six, Seven, or Eight Years Old 

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