Materiały źródłowe

• #1 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease

  Treatment for Perthes focuses on helping the bone grow back into a more rounded shape that still fits into the cup-shaped acetabulum (the socket of the hip joint). This will help the hip joint move normally and prevent hip problems in adulthood. […] The goal of treatment is to relieve painful symptoms, protect the shape of the femoral head, and restore normal hip movement. If left untreated, the femoral head can deform and not fit well within the acetabulum (hip socket), which can lead to further hip problems in adulthood, such as early onset of arthritis. […] There are many treatment options for Perthes disease. Your doctor will consider several factors when developing a treatment plan for your child, including: Your child’s age. Younger children (age 6 and below) have a greater potential for developing a round femoral head after healing.

• #2 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Treatment for Perthes focuses on helping the bone grow back into a more rounded shape that still fits into the cup-shaped acetabulum (the socket of the hip joint). This will help the hip joint move normally and prevent hip problems in adulthood. […] The goal of treatment is to relieve painful symptoms, protect the shape of the femoral head, and restore normal hip movement. If left untreated, the femoral head can deform and not fit well within the acetabulum (hip socket), which can lead to further hip problems in adulthood, such as early onset of arthritis. […] There are many treatment options for Perthes disease. Your doctor will consider several factors when developing a treatment plan for your child, including: Your child’s age. Younger children (age 6 and below) have a greater potential for developing a round femoral head after healing.

• #3 Legg-Calve-Perthes disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348

  In Perthes disease, the complete healing process can take several years. The types of treatment recommended depend on the: […] As Perthes disease gets worse, the ball part of the joint, called the femoral head, weakens and breaks apart. During healing, the socket part of the joint can serve as a mold. This can help the weakened femoral head keep its round shape. […] For this molding to work, the femoral head must sit snugly within the socket. Sometimes a child wears a special type of leg cast that spreads the legs widely apart for 4 to 6 weeks to keep the bone in the right position. […] Some children need surgery to help keep the ball of the joint snug within the socket. This procedure might involve making wedge-shaped cuts in the thighbone or pelvis to align the joint again. […] Surgery generally isn’t needed for children younger than 6. In this age group, the hip socket is naturally more moldable, so the ball and socket usually continue to fit together well without surgery.

• #4 Legg-Calve-Perthes (Perthes Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/legg-calve-perthes-disease

  Treatment for Legg-Calve-Perthes depends on how severe the disease is, what stage it’s in and how old your child is. In general, younger kids, whose bones grow faster, tend to do better with less intervention, while older ones might need more. A healthcare team will develop a personalized treatment plan. […] This plan may include: […] Restricted activity and weight bearing on their affected hip. Your child might need to stop or limit walking for a while, or use an assistive walking device, like crutches, to get around. […] Nonsteroidal anti-inflammatory drugs (NSAIDs). These over-the-counter (OTC) medications can help manage pain and reduce inflammation in the hip joint. They include aspirin and ibuprofen. […] Physical therapy. A physical therapist will work with your child to rehabilitate their hip by prescribing special exercises. You might need to help your child practice their exercises.

• #5 Management of Perthes’ disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4292319/

  Containment is the term used to describe any intervention that places the antero-lateral part of the femoral epiphysis well into the acetabulum thereby protecting the vulnerable part of the epiphysis from being subjected to deforming stresses. […] Extrusion invariably occurs sooner or later in children over the age of 7 years at the onset of the disease and hence containment should be ensured as soon as the disease is diagnosed. […] It is important that their advice is followed as the odds ratio of avoiding femoral head deformation is 16.58 times higher if containment is achieved early in the disease (Stage IIa or earlier) than if it is achieved late in the disease (Stage IIb or later). […] The effect of surgical containment lasts throughout the course of the disease, but the containment effect of bracing or casting is present only as long as the device is worn.

• #6 Legg-Calve-Perthes Disease | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/legg-calve-perthes-disease

  The main goal in LCPD treatment is to achieve a spherical femoral head and concentric joint at the conclusion of the disease process, thereby remaining within Stulberg class I and II. […] Standard treatment options include symptomatic treatment and containment treatment. Symptomatic treatment typically includes activity modifications, protected weightbearing, and physical therapy focused on maintaining hip range of motion, specifically abduction. […] Containment treatment, which means to position the anterior-lateral portion of the femoral epiphysis within the acetabulum in order to prevent deformation, can be performed through either operative or non-operative means. […] Non-operative containment can be achieved through Petrie casting and abduction bracing. […] Surgical containment can be achieved through either varus-producing intertrochanteric femoral osteotomy or pelvic osteotomy.

• #7 Management of Perthes’ disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4292319/

  Containment is the term used to describe any intervention that places the antero-lateral part of the femoral epiphysis well into the acetabulum thereby protecting the vulnerable part of the epiphysis from being subjected to deforming stresses. […] Extrusion invariably occurs sooner or later in children over the age of 7 years at the onset of the disease and hence containment should be ensured as soon as the disease is diagnosed. […] It is important that their advice is followed as the odds ratio of avoiding femoral head deformation is 16.58 times higher if containment is achieved early in the disease (Stage IIa or earlier) than if it is achieved late in the disease (Stage IIb or later). […] The effect of surgical containment lasts throughout the course of the disease, but the containment effect of bracing or casting is present only as long as the device is worn.

• #8 Legg-Calve-Perthes disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348

  In Perthes disease, the complete healing process can take several years. The types of treatment recommended depend on the: […] As Perthes disease gets worse, the ball part of the joint, called the femoral head, weakens and breaks apart. During healing, the socket part of the joint can serve as a mold. This can help the weakened femoral head keep its round shape. […] For this molding to work, the femoral head must sit snugly within the socket. Sometimes a child wears a special type of leg cast that spreads the legs widely apart for 4 to 6 weeks to keep the bone in the right position. […] Some children need surgery to help keep the ball of the joint snug within the socket. This procedure might involve making wedge-shaped cuts in the thighbone or pelvis to align the joint again. […] Surgery generally isn’t needed for children younger than 6. In this age group, the hip socket is naturally more moldable, so the ball and socket usually continue to fit together well without surgery.

• #9 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease

  Nonsurgical Treatment: Observation. For very young children (2 to 6 years old) who show few changes in the femoral head on their initial X-rays, the recommended treatment is usually simple observation. […] Anti-inflammatory medications. Painful symptoms are caused by inflammation of the hip joint. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation, and your child’s doctor may recommend them for several months. […] Limiting activity. Avoiding high-impact activities, such as running and jumping, will help relieve pain and protect the femoral head. […] Physical therapy exercises. Hip stiffness is common in children with Perthes disease and physical therapy exercises are recommended to help restore hip joint range of motion. […] Casting and bracing. If range of motion becomes limited, or if X-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.

• #10 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Nonsurgical Treatment: Observation. For very young children (2 to 6 years old) who show few changes in the femoral head on their initial X-rays, the recommended treatment is usually simple observation. […] Anti-inflammatory medications. Painful symptoms are caused by inflammation of the hip joint. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation, and your child’s doctor may recommend them for several months. […] Limiting activity. Avoiding high-impact activities, such as running and jumping, will help relieve pain and protect the femoral head. […] Physical therapy exercises. Hip stiffness is common in children with Perthes disease and physical therapy exercises are recommended to help restore hip joint range of motion. […] Casting and bracing. If range of motion becomes limited, or if X-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.

• #11 Legg-Calve-Perthes disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348

  Some children, especially very young ones, might need only conservative treatments or observation. Conservative treatments can include: […] Activity restrictions. Children with Perthes disease should not run, jump or take part in other high-impact activities that might speed up hip damage. […] Crutches. Sometimes, your child may need to avoid bearing weight on the affected hip. Using crutches can help protect the joint. […] Physical therapy. As the hip stiffens, the muscles and ligaments around it may shorten. Stretching exercises can help keep the hip more flexible. […] Anti-inflammatory medicines. Your healthcare professional might recommend infants’ or children’s medicines that you can buy without a prescription, such as ibuprofen (Advil, Motrin, others) to help relieve your child’s pain.

• #12 Legg-Calve-Perthes (Perthes Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/legg-calve-perthes-disease

  Treatment for Legg-Calve-Perthes depends on how severe the disease is, what stage it’s in and how old your child is. In general, younger kids, whose bones grow faster, tend to do better with less intervention, while older ones might need more. A healthcare team will develop a personalized treatment plan. […] This plan may include: […] Restricted activity and weight bearing on their affected hip. Your child might need to stop or limit walking for a while, or use an assistive walking device, like crutches, to get around. […] Nonsteroidal anti-inflammatory drugs (NSAIDs). These over-the-counter (OTC) medications can help manage pain and reduce inflammation in the hip joint. They include aspirin and ibuprofen. […] Physical therapy. A physical therapist will work with your child to rehabilitate their hip by prescribing special exercises. You might need to help your child practice their exercises.

• #13 Nonsurgical Treatment for Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/treatments/nonsurgical-treatment-for-legg-calve-perthes-disease-in-children

  Doctors at Hassenfeld Childrens Hospital at NYU Langone focus on identifying and treating Legg-Calv-Perthes disease, also called Perthes disease, before the ball of the hip joint, or femoral head, becomes misshapen. Nonsurgical treatments are often highly effective in helping a young childs hip joint to heal properly. […] Physical therapy is usually the first treatment for children with mild symptoms of Perthes disease and typically begins as soon as a child has been diagnosed. Physical therapy can help to restore range of motion in the hip joint, reduce inflammation and pain, and protect the joint as it heals. […] Occasionally, our doctors may recommend using a removable Petrie cast to keep the ball of the hip joint embedded in the socket as the joint heals. […] Assistive devices, such as crutches, a walker, or a reclining wheelchair for traveling long distances, may be used to take pressure off of the hip and to prevent further injury to the joint. […] Medications such as bisphosphonates may be recommended to help rebuild bone in children older than age six who have Perthes disease. Anti-inflammatory medications may also be prescribed to reduce inflammation in the joint or tissues surrounding the hip joint.

• #14 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease

  Nonsurgical Treatment: Observation. For very young children (2 to 6 years old) who show few changes in the femoral head on their initial X-rays, the recommended treatment is usually simple observation. […] Anti-inflammatory medications. Painful symptoms are caused by inflammation of the hip joint. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation, and your child’s doctor may recommend them for several months. […] Limiting activity. Avoiding high-impact activities, such as running and jumping, will help relieve pain and protect the femoral head. […] Physical therapy exercises. Hip stiffness is common in children with Perthes disease and physical therapy exercises are recommended to help restore hip joint range of motion. […] Casting and bracing. If range of motion becomes limited, or if X-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.

• #15 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Nonsurgical Treatment: Observation. For very young children (2 to 6 years old) who show few changes in the femoral head on their initial X-rays, the recommended treatment is usually simple observation. […] Anti-inflammatory medications. Painful symptoms are caused by inflammation of the hip joint. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation, and your child’s doctor may recommend them for several months. […] Limiting activity. Avoiding high-impact activities, such as running and jumping, will help relieve pain and protect the femoral head. […] Physical therapy exercises. Hip stiffness is common in children with Perthes disease and physical therapy exercises are recommended to help restore hip joint range of motion. […] Casting and bracing. If range of motion becomes limited, or if X-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.

• #16 Legg-Calve-Perthes (Perthes Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/legg-calve-perthes-disease

  Treatment for Legg-Calve-Perthes depends on how severe the disease is, what stage it’s in and how old your child is. In general, younger kids, whose bones grow faster, tend to do better with less intervention, while older ones might need more. A healthcare team will develop a personalized treatment plan. […] This plan may include: […] Restricted activity and weight bearing on their affected hip. Your child might need to stop or limit walking for a while, or use an assistive walking device, like crutches, to get around. […] Nonsteroidal anti-inflammatory drugs (NSAIDs). These over-the-counter (OTC) medications can help manage pain and reduce inflammation in the hip joint. They include aspirin and ibuprofen. […] Physical therapy. A physical therapist will work with your child to rehabilitate their hip by prescribing special exercises. You might need to help your child practice their exercises.

• #17 Nonsurgical Treatment for Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/treatments/nonsurgical-treatment-for-legg-calve-perthes-disease-in-children

  Doctors at Hassenfeld Childrens Hospital at NYU Langone focus on identifying and treating Legg-Calv-Perthes disease, also called Perthes disease, before the ball of the hip joint, or femoral head, becomes misshapen. Nonsurgical treatments are often highly effective in helping a young childs hip joint to heal properly. […] Physical therapy is usually the first treatment for children with mild symptoms of Perthes disease and typically begins as soon as a child has been diagnosed. Physical therapy can help to restore range of motion in the hip joint, reduce inflammation and pain, and protect the joint as it heals. […] Occasionally, our doctors may recommend using a removable Petrie cast to keep the ball of the hip joint embedded in the socket as the joint heals. […] Assistive devices, such as crutches, a walker, or a reclining wheelchair for traveling long distances, may be used to take pressure off of the hip and to prevent further injury to the joint. […] Medications such as bisphosphonates may be recommended to help rebuild bone in children older than age six who have Perthes disease. Anti-inflammatory medications may also be prescribed to reduce inflammation in the joint or tissues surrounding the hip joint.

• #18 Legg-Calvé-Perthes Disease – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/bone-disorders-in-children/legg-calv%C3%A9-perthes-disease

  Treatment of Legg-Calv-Perthes disease includes prolonged bed rest and immobilization of the hip (for example, with a cast or splint). The choice of treatment depends on the child’s age and amount of bone damage. Sometimes the partial immobilization provided by bed rest is sufficient. However, sometimes nearly total immobilization using traction, slings, plaster casts, or splints for 12 to 18 months is necessary. Such treatments keep the legs rotated outward. […] Physical therapy is used to keep the muscles from tightening up and wasting away. […] If a child is over 6 years of age and has moderate or severe bone destruction, surgery may be helpful. […] Treatment with bisphosphonates (drugs that help increase bone density) has been effective, but more studies are needed.

• #19 Guide | Physical Therapy Guide to Perthes Disease | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-legg-calve-perthes-disease

  Perthes disease (also known as Legg-Calv-Perthes disease) is a rare pediatric hip condition. […] Physical therapists help these children with Perthes disease: Regain motion of the hip joint. Decrease inflammation and pain. Strengthen muscles around the hip. Learn to use prescribed braces or crutches throughout the healing process. […] A physical therapist will carefully examine the child. They will develop an exercise program designed to help restore normal hip movement and promote age-appropriate functional skills. […] Based on each child’s condition, a physical therapy treatment plan will be designed to help: Reduce hip pain and inflammation. Restore and maintain hip range of motion and strength. Teach the child how to use crutches, walkers, or other devices to help decrease the stress on the hip when needed. Educate parents and caregivers on safe positioning.

• #20 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Nonsurgical Treatment: Observation. For very young children (2 to 6 years old) who show few changes in the femoral head on their initial X-rays, the recommended treatment is usually simple observation. […] Anti-inflammatory medications. Painful symptoms are caused by inflammation of the hip joint. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation, and your child’s doctor may recommend them for several months. […] Limiting activity. Avoiding high-impact activities, such as running and jumping, will help relieve pain and protect the femoral head. […] Physical therapy exercises. Hip stiffness is common in children with Perthes disease and physical therapy exercises are recommended to help restore hip joint range of motion. […] Casting and bracing. If range of motion becomes limited, or if X-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.

• #21 Legg-Calve-Perthes disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348

  In Perthes disease, the complete healing process can take several years. The types of treatment recommended depend on the: […] As Perthes disease gets worse, the ball part of the joint, called the femoral head, weakens and breaks apart. During healing, the socket part of the joint can serve as a mold. This can help the weakened femoral head keep its round shape. […] For this molding to work, the femoral head must sit snugly within the socket. Sometimes a child wears a special type of leg cast that spreads the legs widely apart for 4 to 6 weeks to keep the bone in the right position. […] Some children need surgery to help keep the ball of the joint snug within the socket. This procedure might involve making wedge-shaped cuts in the thighbone or pelvis to align the joint again. […] Surgery generally isn’t needed for children younger than 6. In this age group, the hip socket is naturally more moldable, so the ball and socket usually continue to fit together well without surgery.

• #22 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease

  Nonsurgical Treatment: Observation. For very young children (2 to 6 years old) who show few changes in the femoral head on their initial X-rays, the recommended treatment is usually simple observation. […] Anti-inflammatory medications. Painful symptoms are caused by inflammation of the hip joint. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation, and your child’s doctor may recommend them for several months. […] Limiting activity. Avoiding high-impact activities, such as running and jumping, will help relieve pain and protect the femoral head. […] Physical therapy exercises. Hip stiffness is common in children with Perthes disease and physical therapy exercises are recommended to help restore hip joint range of motion. […] Casting and bracing. If range of motion becomes limited, or if X-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.

• #23 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Nonsurgical Treatment: Observation. For very young children (2 to 6 years old) who show few changes in the femoral head on their initial X-rays, the recommended treatment is usually simple observation. […] Anti-inflammatory medications. Painful symptoms are caused by inflammation of the hip joint. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation, and your child’s doctor may recommend them for several months. […] Limiting activity. Avoiding high-impact activities, such as running and jumping, will help relieve pain and protect the femoral head. […] Physical therapy exercises. Hip stiffness is common in children with Perthes disease and physical therapy exercises are recommended to help restore hip joint range of motion. […] Casting and bracing. If range of motion becomes limited, or if X-rays or other image scans indicate that a deformity is developing, a cast or brace may be used to keep the head of the femur in its normal position within the acetabulum.

• #24 Legg-Calve-Perthes (Perthes Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/legg-calve-perthes-disease

  Traction. An orthopedic traction device applies gentle, progressive force to gradually stretch or pull the hip joint into alignment. This treatment takes place over a series of several days. […] Casts or braces. During the remodeling phase, your provider might suggest using a cast or brace to keep the bone fixed in the socket. The socket can help mold the bone as it regrows. […] Surgery. Some children might need surgery to help reshape and refit the bone in the socket. This is called osteotomy. Some might need arthroplasty to extend or reshape the hip socket.

• #25 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Surgical Treatment: Your child’s doctor may recommend surgery to re-establish the proper alignment of the bones of the hip and to keep the head of the femur deep within the acetabulum until healing is complete. […] The most common surgical procedure for treating Perthes disease is an osteotomy. In this type of procedure, the bone is cut and repositioned to keep the femoral head snugly within the acetabulum.

• #26 Legg-Calve-Perthes Disease Treatment & Management: Medical Therapy, Surgical Therapy, Complications

  https://emedicine.medscape.com/article/1248267-treatment

  Consultation with an orthopedist is recommended. Goals in the treatment of Legg-Calv-Perthes disease (LCPD) include the following: Eliminating hip irritability, Restoring and maintaining good range of motion (ROM) in the hip, Preventing femoral epiphyseal collapse, Attaining a spherical femoral head when the hip heals. […] Initial therapy includes minimal weightbearing and protection of the joint, which is accomplished by maintaining the femur abducted and internally rotated so that the femoral head is held well inside the rounded portion of the acetabulum. Abduction and rotation of the femur are accomplished by means of either the use of orthotic devices (bracing) or surgery (osteotomy). The Scottish Rite brace achieves containment by abduction while allowing free knee motion. […] Results of surgical containment appear to be better than those of nonsurgical containment (orthosis). Surgery does not speed healing of the femoral head, but it does cause the head to reossify in a more spherical fashion.

• #27 Legg-Calve-Perthes Disease Treatment & Management: Medical Therapy, Surgical Therapy, Complications

  https://emedicine.medscape.com/article/1248267-treatment

  Surgical management typically involves either femoral osteotomy to redirect the involved portion within the acetabulum or innominate osteotomy. The two procedures yield equivalent results, but femoral osteotomy may cause shortening of the limb, leading to a chronic limp. […] A systematic review and meta-analysis by Adulkasem et al found that for severe LCPD, combined osteotomy was the most effective procedure. […] A meta-analysis of the medical literature addressing the effectiveness of surgical and nonsurgical treatment of LCPD suggested that there is minimal evidence to determine the most appropriate treatment. This research also provides some evidence that nontreatment may be as effective as orthotic or surgical intervention. […] Pailh et al conducted a prospective study of 45 patients who underwent triple osteotomy of the pelvis for the treatment of LCPD (mean follow-up, 15.2 y). The investigators concluded that triple osteotomy provides satisfactory, reproducible long-term results.

• #28 Legg-Calve-Perthes Disease Treatment & Management: Medical Therapy, Surgical Therapy, Complications

  https://emedicine.medscape.com/article/1248267-treatment

  Consultation with an orthopedist is recommended. Goals in the treatment of Legg-Calv-Perthes disease (LCPD) include the following: Eliminating hip irritability, Restoring and maintaining good range of motion (ROM) in the hip, Preventing femoral epiphyseal collapse, Attaining a spherical femoral head when the hip heals. […] Initial therapy includes minimal weightbearing and protection of the joint, which is accomplished by maintaining the femur abducted and internally rotated so that the femoral head is held well inside the rounded portion of the acetabulum. Abduction and rotation of the femur are accomplished by means of either the use of orthotic devices (bracing) or surgery (osteotomy). The Scottish Rite brace achieves containment by abduction while allowing free knee motion. […] Results of surgical containment appear to be better than those of nonsurgical containment (orthosis). Surgery does not speed healing of the femoral head, but it does cause the head to reossify in a more spherical fashion.

• #29 Legg-Calve Perthes Disease Treatment West Palm Beach, FL | Hip Pain New York, NY

  https://www.davidsfeldmanmd.com/legg-calve-perthes-disease-orthopedic-surgeon-west-palm-beach.html

  Often, placing children with Legg-Calve-Perthes disease in a specialized brace or cast combined with physical therapy is all that is needed to resolve the condition. Using crutches or a walker to limit the amount of weight bearing on the affected hip/lower extremity can also help with recovery. […] Advanced and severe cases of Legg-Calve-Perthes typically require a multi-faceted course of treatment that combines physical therapy and medication with surgery. […] In cases of Perthes disease, a minimally invasive (percutaneous) procedure is performed to release the adductor muscle. The procedure is often combined with bracing, casting, and/or the surgical procedures listed below. […] Core decompression is a surgical procedure that stimulates healing of the femoral head by removing the hardened dead bone to accelerate new bone formation. […] An osteotomy is a surgical procedure where a deformed bone is broken and reset. […] Arthrodiastasis involves separating or distracting the hips ball from the socket to reduce pressure on the soft femoral head while allowing it to regain its normal shape as it heals.

• #30 Legg-Calve Perthes Disease Treatment West Palm Beach, FL | Hip Pain New York, NY

  https://www.davidsfeldmanmd.com/legg-calve-perthes-disease-orthopedic-surgeon-west-palm-beach.html

  Often, placing children with Legg-Calve-Perthes disease in a specialized brace or cast combined with physical therapy is all that is needed to resolve the condition. Using crutches or a walker to limit the amount of weight bearing on the affected hip/lower extremity can also help with recovery. […] Advanced and severe cases of Legg-Calve-Perthes typically require a multi-faceted course of treatment that combines physical therapy and medication with surgery. […] In cases of Perthes disease, a minimally invasive (percutaneous) procedure is performed to release the adductor muscle. The procedure is often combined with bracing, casting, and/or the surgical procedures listed below. […] Core decompression is a surgical procedure that stimulates healing of the femoral head by removing the hardened dead bone to accelerate new bone formation. […] An osteotomy is a surgical procedure where a deformed bone is broken and reset. […] Arthrodiastasis involves separating or distracting the hips ball from the socket to reduce pressure on the soft femoral head while allowing it to regain its normal shape as it heals.

• #31 Surgical Treatment for Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/treatments/surgical-treatment-for-legg-calve-perthes-disease-in-children

  Surgery for Legg-Calv-Perthes disease, also called Perthes disease, is usually reserved for children ages seven and older whose symptoms are less likely to be managed effectively by physical therapy or a cast. […] Depending on your child’s symptoms, orthopedic surgeons at Hassenfeld Children’s Hospital at NYU Langone can help you to choose the most appropriate surgical procedure. […] Core decompression is an outpatient procedure performed in the hospital that may be used to help the hip joint heal on its own. […] This procedure is often combined with bone grafting, in which the surgeon transplants healthy bone tissue, usually from the child’s pelvis, into the hip to stimulate healing. […] Core decompression surgery is only recommended in the early stages of Perthes disease, before the femoral head has collapsed, or flattened, and no longer fits neatly into the hip socket, known as the acetabulum.

• #32

  https://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease

  Large recent studies show improved outcomes with surgery for lateral pillar B and B/C in children 8 years (bone age 6 years). […] Studies suggest earlier surgery before femoral head deformity develops may be best. […] Hip arthroscopy is an emerging treatment modality for mechanical abnormalities in the setting of healed LCPD. […] Hip arthrodiastasis is indicated for controversial indications and outcomes, utilizing hip distraction via external fixation.

• #33 Management of Perthes’ disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4292319/

  The author advocates avoiding weight-bearing in addition to containment as some reports suggest that combining weight relief with containment may be beneficial. […] Treatment in the late part of the stage of fragmentation or in the early part of the stage of reconstitution attempts to minimize the effects of early deformation of the femoral head that has already occurred. […] A valgus femoral osteotomy overcomes the hinging and brings a more congruent surface of the femoral head under the acetabulum. […] The role of containment at this phase of the disease remains uncertain. […] Apart from containment (which is most widely practiced) some surgeons have attempted arthrodiatasis or joint distraction with an external fixator in an attempt to unload the hip and facilitate the restoration of epiphyseal height.

• #34

  https://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease

  Large recent studies show improved outcomes with surgery for lateral pillar B and B/C in children 8 years (bone age 6 years). […] Studies suggest earlier surgery before femoral head deformity develops may be best. […] Hip arthroscopy is an emerging treatment modality for mechanical abnormalities in the setting of healed LCPD. […] Hip arthrodiastasis is indicated for controversial indications and outcomes, utilizing hip distraction via external fixation.

• #35 Legg-Calve-Perthes disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348

  In Perthes disease, the complete healing process can take several years. The types of treatment recommended depend on the: […] As Perthes disease gets worse, the ball part of the joint, called the femoral head, weakens and breaks apart. During healing, the socket part of the joint can serve as a mold. This can help the weakened femoral head keep its round shape. […] For this molding to work, the femoral head must sit snugly within the socket. Sometimes a child wears a special type of leg cast that spreads the legs widely apart for 4 to 6 weeks to keep the bone in the right position. […] Some children need surgery to help keep the ball of the joint snug within the socket. This procedure might involve making wedge-shaped cuts in the thighbone or pelvis to align the joint again. […] Surgery generally isn’t needed for children younger than 6. In this age group, the hip socket is naturally more moldable, so the ball and socket usually continue to fit together well without surgery.

• #36

  https://www.shrinerschildrens.org/en/pediatric-care/legg-calve-perthes

  Treatment options for Legg-Calv-Perthes vary, and your child will receive a personalized treatment plan that incorporates the most advanced and innovative techniques. Our focus is early detection and a customized treatment plan that is as noninvasive as possible. […] Children under 6 years old tend to respond best to non-surgical interventions, which may include anti-inflammatory medications, activity restrictions (crutches or a wheelchair to reduce weight bearing), bracing or casting, and physical therapy to maintain motion. […] Surgery of the femur or the socket may be necessary to improve the shape of the joint so that the femoral head remains covered by the socket, and to prevent future arthritis.

• #37 Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/15466720/

  The treatment of Legg-Calve-Perthes disease has been based on uncontrolled retrospective studies with relatively small numbers of patients. This large, controlled, prospective, multicenter study was designed to determine the effect of treatment and other risk factors on the outcome in patients with this disorder. […] The five treatment groups consisted of no treatment, brace treatment, range-of-motion exercises, femoral osteotomy, and innominate osteotomy. […] There were no differences in outcome among the hips with no treatment, those treated with bracing, and those treated with range-of-motion therapy. There were also no differences between the hips treated with a femoral varus osteotomy and those treated with an innominate osteotomy. Treatment did not have a significant effect on children who had a chronologic age of 8.0 years or less or a skeletal age of 6.0 years or less at the onset of the disease.

• #38 Legg-Calve-Perthes Disease | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/legg-calve-perthes-disease

  The type of treatment recommended is based on patients age, stage of disease, and radiographic class. […] Patients with onset after 11 years or lateral pillar class C have been considered to have a poor prognosis no matter the treatment type. […] However, evidence shows that radiographic stage is a stronger determinant of prognosis than age, with poor outcomes still occurring at this young age in Catterall class III/IV and lateral pillar class C hips. […] The classic studies by Herring et al suggested that surgical containment resulted in best outcomes in children over 8 years old with Catterall class III or IV, and lateral pillar class B or B/C border hips. […] However, recently it has been appreciated that containment treatment is most effective when initiated in the early stages of disease (prior to when the lateral pillar classification can be made in late fragmentation) or prior to hip extrusion regardless of age.

• #39 Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/15466720/

  In the lateral pillar B group and B/C border group, the outcomes of surgical treatment were significantly better than those of nonoperative treatment in children over the age of 8.0 years at the onset of the disease (p or = 0.05). Patients who were 8.0 years old or less at the onset of the disease in lateral pillar group B did equally well with nonoperative and operative treatment. Hips in lateral pillar group C had the least favorable outcomes, with no differences between the operative and nonoperative groups. […] The lateral pillar classification and age at the time of onset of the disease strongly correlate with outcome in patients with Legg-Calve-Perthes disease. Patients who are over the age of 8.0 years at the time of onset and have a hip in the lateral pillar B group or B/C border group have a better outcome with surgical treatment than they do with nonoperative treatment. Group-B hips in children who are less than 8.0 years of age at the time of onset have very favorable outcomes unrelated to treatment, whereas group-C hips in children of all ages frequently have poor outcomes, which also appear to be unrelated to treatment.

• #40 Management of Perthes’ disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4292319/

  The main complication of Perthes disease is femoral head deformation. […] Several treatment options have been described in children who present later in the course of the disease but the outcomes of all these measures do not compare with those of early intervention. […] The major emphasis of this article is to highlight a rational approach of treatment that aims to prevent the femoral head from getting deformed by intervening early in the course of the disease. Treatment options later in the course of the disease have also been mentioned. […] The aim of treatment of these susceptible children should be to prevent the femoral head from getting deformed. […] Treatment early in the course of the disease (i.e. from the onset to the early stage of fragmentation) attempts to prevent the femoral head from bearing forces across the acetabular margin by either preventing or reversing extrusion of the femoral head by containment.

• #41 Management of Perthes’ disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4292319/

  The author advocates avoiding weight-bearing in addition to containment as some reports suggest that combining weight relief with containment may be beneficial. […] Treatment in the late part of the stage of fragmentation or in the early part of the stage of reconstitution attempts to minimize the effects of early deformation of the femoral head that has already occurred. […] A valgus femoral osteotomy overcomes the hinging and brings a more congruent surface of the femoral head under the acetabulum. […] The role of containment at this phase of the disease remains uncertain. […] Apart from containment (which is most widely practiced) some surgeons have attempted arthrodiatasis or joint distraction with an external fixator in an attempt to unload the hip and facilitate the restoration of epiphyseal height.

• #42 Legg-Calve-Perthes Disease | Pediatric Orthopaedic Society of North America (POSNA)

  https://posna.org/physician-education/study-guide/legg-calve-perthes-disease

  Valgus intertrochanteric osteotomy has also been described as a treatment option in LCPD. […] Patients with residual deformity after healed Perthes disease may have anatomic deformities including femoral-acetabular impingement (FAI) and acetabular dysplasia. […] Treatment is aimed at repairing or minimizing these residual deformities. […] When these treatment options fail, total hip replacement may be required.

• #43 Management of Perthes’ disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4292319/

  Total hip replacement is required once secondary degenerative arthritis develops. […] These observations underscore the overwhelming reason for early preventive intervention in order to preserve the sphericity of the femoral head during the early part of Perthes disease. […] Treatment of Perthes disease should aim at preventing femoral head deformation, thereby minimizing the risk of secondary degenerative arthritis. This is possible in a large proportion of instances if the hip is contained early in the course of the disease.

• #44 Physiotherapy in Huntsville for Hip Issues – 4365

  https://www.proactiverehab.com/Injuries-Conditions/Hip/Research-Articles/Hip-Replacement-for-Adults-who-had-Perthes/a~4365/article.html

  Hip replacement in adults who had Perthes disease as a child is technically challenging and difficult but entirely possible and with good results. […] Total hip replacement is a challenge for these patients because of the odd shape of the hip and leg length differences. […] With some creative modifications (aligning femoral stems and placing cups on the socket side at just the right angle), it is possible to restore good hip biomechanics. […] Their success rate is impressive with 96.9 per cent implant survival after 15 years and an overall complication rate of 12.5 per cent. […] The authors conclude that hip replacement in adults who had Perthes disease as a child is possible. […] Much preoperative planning goes into a procedure like this. Careful examination of the patient and evaluation of imaging studies (X-rays and CT scans) is required.

• #45 Biologic and Pharmacologic Treatment of Legg-Calvé-Perthes Disease | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-0716-0854-8_10

  Biologic or pharmaceutical treatment in Legg-Calve-Perthes disease (LCPD) through modulation of bone resorption, bone formation, and inflammation carries the potential to alter disease progression. […] Modulators of bone resorption, such as bisphosphonates and receptor activator of NF- ligand inhibitors, are the most studied agents and are starting to be evaluated in children. […] Anabolic agents like bone morphogenic proteins and statins may eventually provide a strong adjunct to bisphosphonates. […] The regulation of inflammatory cytokines may impact the pathophysiology and symptomatology of LCPD. […] Further research on these and other agents is needed to elucidate delivery techniques, dosage, efficacy, and safety in humans. […] Evidence for using bisphosphonate to treat Legg-Calve-Perthes disease.

• #46 Legg-Calve-Perthes Disease | PM&R KnowledgeNow

  https://now.aapmr.org/legg-calve-perthe-disease/

  Antiresorptive agents may provide useful adjunctive therapy. Animal studies of ischemic osteonecrosis of hip indicated that combined treatment of bone morphogenetic protein (BMP)-2 with bisphosphonates can decrease bone resorption, increase new bone formation and preserve the femoral head shape. In addition, treatment with Strontium ranelate in rat models has shown prevention in collapse of the ischemic FH and enhanced trabecular thickness. […] There is a need for well designed, controlled studies to explore new treatment options for advanced LCPD, since neither conservative nor operative management showed desirable outcomes. In addition, antiresorptive and anabolic agents need further investigation to assess their clinical efficacy in the treatment of LCP disease.

• #47 Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/15466720/

  The treatment of Legg-Calve-Perthes disease has been based on uncontrolled retrospective studies with relatively small numbers of patients. This large, controlled, prospective, multicenter study was designed to determine the effect of treatment and other risk factors on the outcome in patients with this disorder. […] The five treatment groups consisted of no treatment, brace treatment, range-of-motion exercises, femoral osteotomy, and innominate osteotomy. […] There were no differences in outcome among the hips with no treatment, those treated with bracing, and those treated with range-of-motion therapy. There were also no differences between the hips treated with a femoral varus osteotomy and those treated with an innominate osteotomy. Treatment did not have a significant effect on children who had a chronologic age of 8.0 years or less or a skeletal age of 6.0 years or less at the onset of the disease.

• #48 Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/15466720/

  In the lateral pillar B group and B/C border group, the outcomes of surgical treatment were significantly better than those of nonoperative treatment in children over the age of 8.0 years at the onset of the disease (p or = 0.05). Patients who were 8.0 years old or less at the onset of the disease in lateral pillar group B did equally well with nonoperative and operative treatment. Hips in lateral pillar group C had the least favorable outcomes, with no differences between the operative and nonoperative groups. […] The lateral pillar classification and age at the time of onset of the disease strongly correlate with outcome in patients with Legg-Calve-Perthes disease. Patients who are over the age of 8.0 years at the time of onset and have a hip in the lateral pillar B group or B/C border group have a better outcome with surgical treatment than they do with nonoperative treatment. Group-B hips in children who are less than 8.0 years of age at the time of onset have very favorable outcomes unrelated to treatment, whereas group-C hips in children of all ages frequently have poor outcomes, which also appear to be unrelated to treatment.

• #49 Effectiveness of therapeutic methods for Legg-Calvé-Perthes disease according to staging, limits of conservative treatment: a systematic review with meta-analysis | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/122123-effectiveness-of-therapeutic-methods-for-legg-calve-perthes-disease-according-to-staging-limits-of-conservative-treatment-a-systematic-review-with-m

  Patients with a larger area of injury to the femoral head may be candidates for surgical treatment, such as innominate osteotomy of the pelvis or osteotomy of the hip stem, in order to keep the femoral head as congruent with the pelvis as possible. […] The choice depends on the stage of the disease, the radiographic characteristics of the joint restraint and the patients clinical condition. […] However, all treatments are aimed at preventing deformity of the femoral head, maintaining the sphericity of the femoral head and the congruence of the femur-acetabulum relationship and avoiding secondary degenerative arthritis, which leads to total hip arthroplasty in 5% of cases. […] The data collected by the studies, although with insignificant differences in terms of the number of patients classified in each Stulberg class for conservative and surgical treatment, showed that conservative treatment is more effective before the age of six, associated with a better prognosis, while surgical treatment is better recommended at older ages, or in cases of failure of conservative treatment applied at the indicated age (06 years).

• #50 Legg-Calve-Perthes disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/symptoms-causes/syc-20374343

  To keep the ball part of the joint as round as possible, doctors use a variety of treatments that keep it snug in the socket portion of the joint. […] The complete process of bone death, fracture and renewal can take several years.

• #51 Perthes’ disease | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/perthes-disease

  In most cases, the blood supply to the hip joint returns and the femoral head regenerates by itself. This can take anywhere between 2 and 5 years. […] Treatment of Perthes’ disease aims to make sure the femoral head remains as round as possible, and to reduce joint pain and stiffness. Treatment depends on your child’s age and the severity of their condition, but may include: […] regular monitoring by your doctor, including physical examinations and x-rays […] pain medication […] physiotherapy to help keep the hip joint moving and to help maintain muscle strength […] avoidance of high impact activities such as running and jumping […] a brace, splint or plaster may be used if your child’s range of movement in the hip is affected, or if x-rays show that the femoral head is losing its rounded shape […] short term bed rest may be required when the pain is especially bad […] rest your doctor may advise rest using crutches, a walker or a wheelchair for a period of time […] some children require surgery to treat the deformed femoral head so that it fits snugly within the hip socket.

• #52 Legg-Calve-Perthes Disease | PM&R KnowledgeNow

  https://now.aapmr.org/legg-calve-perthe-disease/

  A multidisciplinary team includes physiatry, PT, occupational therapy, and orthopedics. The physiatrist plays a role in monitoring symptoms, prescribing PT and pain medications, obtaining radiographs, determining weight-bearing status, and referral to a pediatric orthopedist. It is important that all patients establish care with a team to determine treatment options. Follow-up visits focus on symptoms, hip mobility, and disease progression. […] The Iowa Hip Score and Nonarthritic Hip Score are used in addition to the Stulberg classification to evaluate functional outcomes in LCPD. […] Surgery may eliminate longer-term bracing and allow earlier resumption of activities. Operative and nonoperative treatments had comparable rates of good outcome of about 77%. The prognosis is better with early detection (under the age of 8 years). Patients younger than 6 years had better outcome with nonoperative than with operative, whereas the opposite was true for children over 6 years of age. When choosing operation, this younger population tends to have a slightly better outcome with pelvic rather than femoral osteotomy.

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