Treatment of severe late onset Perthes' disease with soft tissue release and articulated hip distraction: early results

Sixteen children with late onset Perthes' disease were surgically treated at an average age of 12 years 1 month (9 years 4 months to 15 years) by soft tissue release and articulated hip distraction. Two patients had additional diagnosis of Down syndrome and one suffered from geleophysic epiphys...

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Bibliographic Details
Published inJournal of pediatric orthopaedics. B Vol. 13; no. 3; p. 158
Main Authors Segev, Eitan, Ezra, Elias, Wientroub, Shlomo, Yaniv, Moshe
Format Journal Article
LanguageEnglish
Published United States 01.05.2004
Subjects
Adolescent
Age of Onset
Arthrography
Child
Cohort Studies
External Fixators
Female
Humans
Legg-Calve-Perthes Disease - diagnostic imaging
Legg-Calve-Perthes Disease - physiopathology
Legg-Calve-Perthes Disease - surgery
Male
Orthopedic Procedures - methods
Pain Measurement
Range of Motion, Articular - physiology
Treatment Outcome
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Summary:Sixteen children with late onset Perthes' disease were surgically treated at an average age of 12 years 1 month (9 years 4 months to 15 years) by soft tissue release and articulated hip distraction. Two patients had additional diagnosis of Down syndrome and one suffered from geleophysic epiphyseal dysplasia. Fifteen hips were graded Catterall IV and Herring C and one hip was graded Catterall III Herring B. On preoperative arthrograms, 14 patients had a saddle-shape subluxating femoral head with hinge abduction. The distraction discontinued when Shenton line was corrected. The fixation lasted 4-5 months. At a mean follow-up of 2 years 7 months (1-5 years), an improvement of hip range of motion was found in all patients. Hip joint arthrograms upon removal of the fixator showed disappearance of the saddle-shape femoral head in 10 of the 14 patients with this deformation. Shenton line breakage improved from 7.6 mm to 2.1 mm at last follow-up. The epiphyseal index improved by 14%. The average pain score on an analog scale dropped from a preoperative 7.0 to 1.6 at last follow-up (filled in by patients or parents in case of Down syndrome). Separate analysis of data from the group having only Perthes disease (13 children) showed better results. These preliminary data suggest that soft tissue release combined with unloading of the femoral head and restoration of joint space can improve the function and epiphyseal height.
ISSN:1060-152X
1473-5865
DOI:10.1097/00009957-200405000-00004