Arthrodiatasis for the Treatment of Perthes' Disease

Abstract

It is hypothesized that the interruption of the blood supply is an important factor causing femoral head osteonecrosis in the early stages of Legg-Calvé-Perthes disease. Currently, treatment by containment is recommended to direct and guide remodeling of the softened femoral head as it evolves from fragmentation through ossification. The goal of this study was to show the results of arthrodiatasis to induce height recovery of the femoral head and to achieve true ambulatory nonweight-bearing containment. Forty-two patients younger than 8 years with a diagnosis of Perthes' disease were studied. Twenty-three patients (9 class B and 14 class C according to Herring's classification) were treated with an articulated distraction technique and 19 patients (11 class B and 8 class C) were treated conservatively as a control group. Arthrodiatasis or articulated distraction of the hip combines off-loading of muscles and body forces with distraction of the joint space by means of an external fixator that crosses the hip joint. Radiologically, 21 patients (91%) had satisfactory results and 2 (9%) had unsatisfactory results. Clinically, the results were good in 21 patients (92%), fair in 1 (4%), and poor in 1 (4%). In patients treated conservatively, 14 patients (72%) had satisfactory results and 5 (28%) had unsatisfactory results. Clinically, 71% had good results, 17% had fair, and 12% had poor. We conclude that hip joint containment by articulated arthrodiatasis (plus adductors and psoas minimal tenotomy surgery) is an effective method in the management of Perthes' disease in patients younger than 8 years, classified B and C, and associated with a highly reduced range of abduction. Restoration of clinical abnormalities and satisfactory radiological parameters are achieved in high percentages.

Operative Management of Avascular Necrosis of the Femoral Head in Skeletally Immature Patients: A Systematic Review

“…Given the lack of quantitative data, bilaterality of ONFH it was not possible to investigate separately. Finally, articles concern-Life 2022, 12, 179 9 of 12 ing Perthes disease have been excluded, as the management of these patients has been extensively analysed in the literature [70][71][72][73][74][75][76][77][78][79][80][81][82], and evidence on non-Perthes related ONFH is limited. Two studies which have been included for analysis reported data on patients with Perthes disease [31,33]; however, since the authors reported the results separately, data from patients with Perthes disease were not considered.…”

Management of Perthes’ disease

“…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. 45 46 The reported results have not been sufficiently encouraging to recommend this as the procedure of choice. 46 Yet another approach has been to drill the epiphysis in the hope that this will hasten re-vascularization; reports on the long term outcome of this method of treatment are awaited.…”

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].…”

“…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.…”