The adult hip after femoral varus osteotomy in patients with unilateral Legg–Calvé–Perthes disease

Schmid, O.; Hemmer, Stefan; Wünsche, Petra; Hirschfelder, H.

doi:10.1097/01202412-200301000-00006

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…In the 1980s, operative methods (femoral and innominate osteotomy) to offer containment became more popular for these patient groups. Advocates of femoral varus osteotomy refer to the 70-90% satisfactory results [24][25][26][27][28][29][30][31][32]. Limited studies compare conservative treatment regime(s) with femoral varus osteotomy and report variable results [13,14,17,20,[33][34][35][36][37][38][39].…”

Section: Introductionmentioning

confidence: 99%

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Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Wagenaar

Maathuis

Erve

2011

Journal of Children's Orthopaedics

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Purpose Compare conservative and operative treatment in the most severely affected Legg-Perthes disease patients. Methods 29 patients (14 conservative and 15 operative) with 32 affected hips (16 conservative and 16 operative) were evaluated, all Catterall 3 or 4. The conservative group, with a median age-at-onset of 4.8 (range, 2.5-9.5) years, was treated by a rigorous regime of traction in abduction for an average of two years. Follow-up was performed at a median of 28.6 (range, 17.4-31.6) years with a median patient age of 34.1 (range, 19.9-39.3) years. The operative group, with a median age-at-onset of 4.7 (range, 2.0-7.8) years, was treated by femoral varus derotation osteotomy. Follow-up was performed at a median of 14 (range, 8-21.4) years, with a median patient age of 20.7 (range, 12.8-28) years. Results Median age-at-onset (P = 0.16) and Catterall classification (P = 0.29) were comparable. No differences could be found for the Stulberg classification (P = 0.83), functional parameters (Harris Hip score and Merle d'Aubigné and Postel), and leg-length differences. Career choices were similar for both patient groups, as well.Conclusions Given methodological issues, femoral varus derotation osteotomy did not show apparent better results than the conservative containment regime in Catterall 3 and 4 patients with a median age-at-onset around 4.8 years. This result is fairly similar to recent literature suggesting a conservative approach in most severely affected patients with a young age-at-onset. However, based on unacceptable socioeconomic issues, the conservative regime evaluated in the present study cannot be justified, nowadays.

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Section: Introductionmentioning

confidence: 99%

“…Advocates of femoral varus osteotomy refer to the 70-90% satisfactory results [24][25][26][27][28][29][30][31][32]. Limited studies compare conservative treatment regime(s) with femoral varus osteotomy and report variable results [13,14,17,20,[33][34][35][36][37][38][39].…”

Section: Introductionmentioning

confidence: 99%

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Wagenaar

Maathuis

Erve

2011

Journal of Children's Orthopaedics

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“…It is not clear what would be the possible benefits from physiotherapy in LCPD or when should it be used. Some studies mention physiotherapy as a pre-and/or postoperative resource, [4][5][6][7] while others consider it a form of conservative treatment associated with other treatments, such as skeletal traction, orthesis, and plaster cast. 3,[8][9][10][11] According to Herring et al, literature includes 1 randomized study and a few controlled studies, most of them without control groups.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Physiotherapy in the Treatment of Legg-Calvé-Perthes Disease

Brech¹,

Guarnieiro²

2006

Clinics

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INTRODUCTION: Physiotherapy using muscle strengthening and stretching exercises is claimed to have beneficial effects in the treatment of Legg-Calvé-Perthes disease; however, no scientific evidence is available concerning effectiveness of treatment. PURPOSE:The purpose of the present study was to clinically evaluate possible effects of the proposed physiotherapeutic effects compared to observational follow-up in patients with Legg-Calvé-Perthes disease. METHOD: A prospective follow-up study was conducted in 17 patients with unilateral Legg-Calvé-Perthes disease, divided into 2 groups: Group A (observational follow-up) and Group B (physiotherapeutic follow-up). In order to evaluate the outcome of the adopted treatments, the following parameters were assessed: articular range of motion, level of muscular strength, level of articular dysfunction, and radiographic status, both before and after the treatment. RESULTS: Group B exhibited significant improvement in articular range of motion concerning hip flexion, extension, abduction, adduction, medial rotation, and lateral rotation, while in Group A an equally significant worsening occurred concerning abduction, adduction, and medial rotation. Muscular strength also improved in Group B, mainly in the set of hip flexor muscles, while Group A showed no changes. Articular dysfunction after therapy compared to pretherapy was significantly reduced in Group B and increased in Group A. Patients undergoing physiotherapy exercises showed no changes in their radiographic features. CONCLUSION: Physiotherapy produced significant improvement in articular range of motion, muscular strength, and articular dysfunction in patients with Legg-Calvé-Perthes disease, but these improvements were not evident on radiographs.

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“…Na fisioterapia foram realizados exercícios no solo e na água, mantendo assim uma boa ADM do quadril. Schmid et al (2003), os pacientes com diminuição da ADM devem realizar fisioterapia antes de serem submetidos a procedimento cirúrgico, como a osteotomia varizante. Wild et al (2003) Quando ocorre a diminuição da ADM do quadril, é indicada a realização de exercícios fisioterapêuticos associados à tração cutânea, antes ou durante a utilização de "brace" de abdução (Aksoy et al, 2004).…”

Section: Guilherme Carlos Brechunclassified

“…A atuação da fisioterapia na DLCP não está muita clara na literatura, seus reais benefícios para a DLCP e quando ela pode ser utilizada. Inúmeros artigos apenas a citam como um recurso pré-operatório e/ou pós-operatório (Jani e Dick, 1980;Ishida et al, 1994;Guarniero et al, 1995;Schmid et al, 2003) ou como uma forma de tratamento conservador associado a outro meio: tração cutânea; órtese; aparelho gessado (Klisic et al, 1980;Bowen et al, 1982;Wang et al, 1995;Futami e Suzuki, 1997;Aksoy et al, 2004) utilizados para os pacientes com DLCP.…”

Section: Análise Da Aderência Ao Tratamento Do Grupo Bunclassified

"Avaliação do tratamento fisioterapêutico da doença de Legg-Calvé-Perthes"

Brech¹

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The adult hip after femoral varus osteotomy in patients with unilateral Legg–Calvé–Perthes disease

Cited by 3 publications

References 14 publications

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Treatment outcome in the most severely affected Legg-Perthes patients, comparing prolonged traction in abduction with femoral varus derotation treatment

Evaluation of Physiotherapy in the Treatment of Legg-Calvé-Perthes Disease

"Avaliação do tratamento fisioterapêutico da doença de Legg-Calvé-Perthes"

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