Management of Legg-Calvé-Perthes disease using an A-frame orthosis and hip range of motion: a 25-year experience
| Autor: | Margaret M. Rich, Perry L. Schoenecker |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
musculoskeletal diseases
Male medicine.medical_specialty Orthotic Devices medicine.medical_treatment Osteotomy Femoral head medicine Deformity Legg-Calve-Perthes disease Humans Orthopedics and Sports Medicine Range of Motion Articular Child Femoral neck Retrospective Studies Orthodontics business.industry Age Factors General Medicine medicine.disease Acetabulum Orthotic device Exercise Therapy Leg Length Inequality Casts Surgical medicine.anatomical_structure Tenotomy Treatment Outcome Child Preschool Pediatrics Perinatology and Child Health Physical therapy Legg-Calve-Perthes Disease Female Hip Joint medicine.symptom Range of motion business Follow-Up Studies |
| Zdroj: | Journal of pediatric orthopedics. 33(2) |
| ISSN: | 1539-2570 |
| Popis: | Background Containment treatment is widely accepted in the management of Legg-Calve-Perthes disease. Many reports indicate the need to regain hip motion before pelvic or femoral osteotomy, but have not indicated how osteotomy affected motion. Recent studies have suggested that osteotomy treatment of lateral pillar B hips may result in a higher proportion of spherical hips than those managed nonoperatively; however, outcomes for children older than 8 years of age or with pillar C involvement remain unsatisfactory. Methods The records of all patients with a diagnosis of Legg-Calve-Perthes disease seen at our facility from 1985 through 2001 were reviewed. Two hundred and thirteen patients (175 males, 38 females), average age 6.4 years (range, 2.6 to 11.3 y), with 240 involved hips in the necrotic or the fragmentation stage were managed under a protocol to restore and maintain satisfactory hip abduction with an adductor tenotomy and abduction cast, followed by daily hip range-of-motion exercises and an A-frame orthosis to facilitate the concentric position of the epiphysis within the acetabulum. Assessment included measurement of hip abduction, femoral head sphericity and congruence, presence of femoral neck deformity, limb-length inequality, and later reconstructive surgical procedures. Hips were grouped by lateral pillar class (12A, 113B, 115C) and evaluated at maturity using a modified Stulberg grade. Results All pillar A hips were spherically congruent. Of pillar B hips, 101 were spherically congruent, 8 were aspherical but congruent, and 4 were aspherical and incongruent. Of pillar C hips, 77 were spherically congruent, 26 were aspherical but congruent, and 12 were aspherical and incongruent. Age did not correlate with outcome. Hip abduction improved and was maintained in all groups. Conclusions Treatment that restored and maintained hip range of motion along with the use of an A-frame orthosis resulted in a high proportion of spherically congruent hips for patients of all ages irrespective of the extent of disease. Seventy-eight percent of pillar B and C hips were spherically congruent hips at maturity; overall, 93% of hips were congruent. This regimen has supplanted all other methods of treatment at our institution. Level of evidence Level IV-case series. |
| Databáze: | OpenAIRE |
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