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

Author:

Wagenaar F. B. M.1,Maathuis C. G. B.2,van Erve R. H. G. P.3

Affiliation:

1. Department of Orthopaedic Surgery, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen The Netherlands

2. Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen The Netherlands

3. Department of Orthopaedic Surgery, Deventer Ziekenhuis, N. Bolkesteinlaan 75, 7416 SE, Deventer The Netherlands

Abstract

PurposeCompare conservative and operative treatment in the most severely affected Legg-Perthes disease patients.Methods29 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.ResultsMedian 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.ConclusionsGiven 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.

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Pediatrics, Perinatology and Child Health

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