Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calvé-Perthes disease: a prospective controlled trial.
OBJECTIVE
Legg-Calvé-Perthes (LCP) disease is currently managed by mechanical containment of the femoral head in the hip socket. As evidence suggests that hip distraction may offer a new treatment strategy, we used arthrodistraction as a primary treatment for active forms of LCP disease and prospectively compared the results with the Salter innominate osteotomy.


METHODS
A total of 54 children, six years or older of both genders with severe forms of LCP disease in the stages of necrosis or revascularisation, were enrolled. Patients were submitted to either Salter innominate osteotomy (n = 28) or hip arthrodistraction (n = 26). Final radiographs were used to evaluate the Mose index, Wiberg angle, extrusion index and the Stulberg et al. classification.


RESULTS
There were no significant differences in gender, age, lateral pillar classification and average follow-up time between the two groups. The osteotomy group progressed without major complications, but children in the joint distraction group experienced episodes of pin tract pain and infection, leading to the early removal of the external device in one case. Two patients developed joint stiffness, treated by physiotherapy or manipulation, and one child developed subluxation of the femoral head. The average time in distraction was 4.44 months (2.53-7.23 months). In the final evaluation the osteotomy group showed better containment of the femoral head. The Mose index and the Stulberg et al. classification were statistically similar between the two groups.


CONCLUSIONS
Despite similar final radiological results, arthrodistraction was associated with a higher morbidity. Consequently, we do not recommend hip distraction as a primary treatment for the early stages of LCP disease.
Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Av Bandeirantes 3900, 14049-900 Ribeirão Preto, Brazil. hc.ortopedia@gmais.com
José Batista
JB
Volpon
D002648:Child; D002675:Child, Preschool; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D062606:Tertiary Care Centers; D063128:Tertiary Health Care