Arthrodiastasis of the Hip

Abstract

Nonarticulated hip distraction without soft tissue release seems to be a valid treatment option in cases with Legg-Calvé-Perthes disease where poor results are expected from conventional treatment.

Management of Late Onset Perthes: Evaluation of Distraction by External Fixator—5-Year Follow-Up

“…After an average follow-up of 3.6 years, they observed an improvement in the range of movements, pain, and superior and lateral subluxation of head, with a statistically significant difference between pre- and postoperative values. Hosny et al [ 20 ] treated 29 children (older than 8 years at onset) with Perthes' disease (lateral pillar type C or B). They observed improvement in range of movements of hip in about 93% of patients.…”

Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calvé-Perthes disease: a prospective controlled trial

“…Several studies have evaluated the role of arthrodistraction in the treatment of Perthes' disease [12][13][14][15][16][17], but with discrete methodologies. Some authors included soft tissue release [16], whereas others used the non-articulated Ilizarov system [15].…”

“…However, this treatment has not been widely accepted, as the literature does not show strong scientific evidence that it is more beneficial for the patient, when compared with traditional methods. Most of the series published to date indicate the benefit of hip distraction in Perthes' disease patients; but these studies are considered preliminary [12], or the series are too small to guarantee reliable conclusions [15][16][17].…”

“…More recently, there has been some evidence to suggest that distraction forces applied to the hip joint can offer mechanical protection to the femoral head and promote bone revascularisation [12][13][14][15][16][17]. Therefore, hip joint distraction may offer an alternative therapeutic option for patients with Legg-Calvé-Perthes disease (otherwise called Perthes' disease), as it represents an attractive link between mechanical and biological processes.…”

Morbus Perthes

“…Diese Methodik wird in unterschiedlichsten Varianten durchgeführt: " Montagen mit unilateralem Fixateur oder Ringfixateur, " artikuliert oder fixiert, " in Kombination mit und ohne Weichteil-Release-Operationen oder Containment verbessernde Eingriffe, " während des Früh-oder Spätstadiums sowie " über unterschiedliche Zeiträume (überwiegend mit einer Behandlungsdauer zwischen 2 und 5 Monaten). Die Erfahrungen mit dieser Methode sind unterschiedlich: Eine Verbesserung der Gelenkbeweglichkeit wird meist erzielt, allerdings wird über zahlreiche Komplikationen (u. a. Pin-Infektionen mit einer Häufigkeit bis zu 80 %) berichtet [45][46][47]. Der Einsatz der Arthrodiastase ist deshalb umstritten.…”