Legg-Calvé-Perthes disease: treatment and prognosis

Abstract

Our experience in the treatment of Legg-Perthes disease using non-containment, containment, and surgical treatment supports the concept that containment is a key factor in the treatment of Legg-Perthes disease. Patients without excessive lateral extrusion or other signs of "head at risk" and half or more of the femoral head involved probably can be treated for short periods of time in an abduction orthosis. If less than half the femoral head is involved but lateral extrusion is minimal, a period of traction to obtain range of motion and decrease the synovitis may be sufficient treatment. In the more severely involved heads that show the poor prognostic signs of excessive lateral extrusion, bed rest in addition to abduction may statistically offer the best chances for a good result. For patients with severe involvement and excessive lateral extrusion of the femoral head, intertrochanteric osteotomy gave us a better percentage of good results than treatment with abduction and weight bearing. Our intertrochanteric osteotomy series results were comparable to those in the Katz and Brotherton and McKibbin patients treated by abduction and nonweight bearing. Regardless of the method of treatment chosen for a specific patient, it is essential that a good range of motion be obtained and maintained throughout the course of treatment. If this is successfully done, regardless of other factors, the outcome should be satisfactory.