A Comparative Study of Ambulation-Abduction Bracing and Varus Derotation Osteotomy in the Treatment of Severe Legg-Calvé-Perthes Disease in Children Over 6 Years of Age

Background: Legg-Calve-Perthes (LCP) disease, or idiopathic avascular necrosis of the femoral head occurs during early childhood and is caused by impaired circulation in the femoral head. Varus derotation osteotomy (VDO) was described over half a century ago, and is now a popular method for the operative treatment of Perthes disease. Objective: To find out the clinical and radiological outcome of varus derotation osteotomy for containment of femoral head in advanced Perthes disease. Materials and Methods: This observational study was conducted in the Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka from March 2015 to September 2017. Total 20 cases of advanced Perthes disease were enrolled. Pre- and post-operative period were evaluated by interview and clinical examination by using a semi-structured questionnaire. Demographic and clinical information were recorded. All patients had a pre- and post-operative x-rays. We used visual analog scales (VAS) for scoring pain; Wiberg’s central edge angle, epiphyseal extraction index, neck shaft angle and Larson (Iowa) hip score were used to assess the outcome of VDO. Comparison of continuous variables between the two groups was made with Student’s t-tests. Comparison of proportions between Herring groups B and C were made with chi-square tests. p<0.05 was considered as significant. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Sciences (SPSS 22.0). Results: In the present study, mean visual analog scale (VAS) score and epiphyseal extraction index (EEI) were significantly (p<0.001) lower in Herring Group B in comparison to that of Group C, but mean WCEA, NSA and HLS were significantly (p<0.001) higher in Herring Group B in comparison to that of Group C. Conclusion: Varus osteotomy gives good results in children aged 6–12 years who do not exhibit any femoral head deformity or flattening, especially those with good containment in abduction in advance Perthes disease. J Enam Med Col 2020; 10(2): 79-85

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Comparative study of serum proteomes in Legg-Calve-Perthes disease

BMC Musculoskeletal Disorders ◽

10.1186/s12891-015-0730-z ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 8

Author(s):

Ruiyu Liu ◽

Lihong Fan ◽

Longbin Yin ◽

Kunzheng Wang ◽

Wusheng Miao ◽

...

Keyword(s):

Comparative Study ◽

Perthes Disease

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Alumina–alumina total hip arthroplasty for the sequelae of Legg-Calve-Perthes disease: A comparative study with adult-onset osteonecrosis

Journal of Orthopaedic Science ◽

10.1016/j.jos.2016.07.010 ◽

2016 ◽

Vol 21 (6) ◽

pp. 836-840 ◽

Cited By ~ 2

Author(s):

Soong Joon Lee ◽

Jeong Joon Yoo ◽

Hee Joong Kim

Keyword(s):

Total Hip Arthroplasty ◽

Comparative Study ◽

Hip Arthroplasty ◽

Perthes Disease ◽

Adult Onset ◽

Total Hip

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Does early and aggressive management of significant extrusion of the femoral head affect the outcome of Perthes’ disease with the age of onset younger than 7 years?

MUSCULOSKELETAL SURGERY ◽

10.1007/s12306-021-00709-8 ◽

2021 ◽

Author(s):

K. A. Singh ◽

N. Harne ◽

H. Shah

Keyword(s):

Age Of Onset ◽

Early Stage ◽

Skeletal Maturity ◽

Perthes Disease ◽

Level Of Evidence ◽

Deviation Score ◽

Aggressive Management ◽

Significant Difference ◽

Derotation Osteotomy

Abstract Background Little literature exists regarding aggressive treatment of the extrusion in the early stage of the disease and the outcome at skeletal maturity. The purpose of the study was to evaluate the outcome of the disease with onset younger than 7 years, treated in the early stage of the disease, with aggressive management of significant extrusion (immediate containment with fixed abduction brace in children less than 5 years and varus derotation osteotomy in older children), and reached skeletal maturity. Methods All children with the age of onset younger than 7 years of disease during active Perthes disease were prospectively followed. Children with early stages of the disease (modified Elizabethtown classification) and reached skeletal maturity were included (68 children). The extrusion of the femur head was calculated by Reimer’s migration index on both sides. A migration difference 12 % or above was considered as “significant extrusion”. Children without significant extrusion were treated non-operatively; children with significant extrusion were treated with varus derotation osteotomy. The final radiological outcome was assessed by the Stulberg classification and sphericity deviation score (SDS). The independent “t” test and Chi-square test were done to compare the difference between the two groups. Results The mean age at the onset and the final follow-up was 5.7 years and 15.3 years. The frequency of significant extrusion was 57%. At the final follow-up, an excellent clinical outcome and radiological outcomes (in 88% hips) were noted. There was no significant difference in the Stulberg groups and SDS (sphericity deviation score) in both groups. Conclusion The outcome of the children who had the age of onset of the disease less than 7 years was good with early and aggressive management of the extrusion. The reversal of extrusion is associated with a similar result of non-operative children in this age group. Level of evidence III.

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