Abstract
There are few more enigmatic conditions than Perthes’ disease. The aetiology, mechanisms and optimal treatments all remain the source of controversy. The wide variety of available treatments provides the clearest demonstration of the uncertainty amongst clinicians treating the disease. Treatment regimens vary considerably from years of not weight bearing, to months of abduction cast treatment, to femoral and pelvic surgical procedures, to observation alone without any specific intervention. The orthopaedic community has little understanding of how treatment influences the natural history of this disease. This review considers the best available evidence, to formulate an evidence-based approach.
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References
Perry DC1, Bruce CE, Pope D, Dangerfield P, Platt MJ, Hall AJ. Legg-Calvé-Perthes disease in the UK: geographic and temporal trends in incidence reflecting differences in degree of deprivation in childhood. Arthritis Rheum. 2012;64:1673–1679.
Perry DC, Machin DM, Pope D, Bruce CE, Dangerfield P, Platt MJ, Hall AJ. Racial and geographic factors in the incidence of Legg-Calvé-Perthes’ Disease: a systematic review. Am J Epidemiol. 2012;175(3):159–66.
Harrison H, Turner M, Nicholson F. Coxa plana: results of a new form of splinting. J Bone Joint Surg Am. 1969;51:1057–69.
Bobechko WP. The Toronto brace for Legg-Perthes disease. Clin Orthop Relat Res. 1974;102:115–7.
Purvis J, Dimon 3rd JH, Meehan PL, Lovell WW. Preliminary experience with the Scottish Rite Hospital abduction orthosis for Legg-Perthes disease. Clin Orthop Relat Res. 1980;150:49–53.
Martinez AG, Weinstein SL, Dietz FR. The weight-bearing abduction brace for the treatment of Legg-Perthes disease. J Bone Joint Surg Am. 1992;74:12–21.
Waldenström H. The Definite Form of the Coxa Plana. Acta Radiol. 1922;1:384.
Joseph B. Management of Perthes’ disease. Indian J Orthop. 2015;49:10–6.
Hyman JE, Trupia EP, Wright ML, Matsumoto H1, Jo CH, Mulpuri K. Interobserver and intraobserver reliability of the modified Waldenström classification system for staging of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 2015;97:643–650.
Wiig O, Terjesen T, Svenningsen S. Inter-observer reliability of the Stulberg classification in the assessment of Perthes disease. J Child Orthop. 2007;1:101–5.
Stulberg S, Cooperman D, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63:1095–108.
Neyt J, Weinstein SL, Spratt KF, Dolan L, Morcuende J, Dietz FR, et al. Stulberg classification system for evaluation of Legg-Calvé-Perthes disease: intra-rater and inter-rater reliability. J Bone Joint Surg Am. 1999;81:1209–16.
Shah H, Siddesh ND, Pai H, Tercier S, Joseph B. Quantitative measures for evaluating the radiographic outcome of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 2013;95:354–61.
Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg Br. 1971;53:37–53.
Salter RB, Thompson GH. Legg-Calvé-Perthes disease. The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am. 1984;66(4):479–89.
Herring JA, Kim HT, Brown R. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1992;12:143–50.
Herring JA, Kim HT, Browne R. Legg-Calvé-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am. 2004;86:2121–34.
Mahadeva D, Chong M, Langton DJ, Turner AM. Reliability and reproducibility of classification systems for Legg-Calvé-Perthes disease: a systematic review of the literature. Acta Orthop Belg. 2010;76(1):48–57.
Nakamura J, Kamegaya M, Saisu T, Kakizaki J, Hagiwara S, Ohtori S. Outcome of patients with Legg-Calvé-Perthes onset before 6 years of age. J Pediatr Orthop. 2015;35(2):144–50.
Rosenfeld S, Chao J, Herring J. Legg-Calve-Perthes disease: a review of cases with onset before six years of age. J Bone Joint Surg Am. 2007;89(12):2712–22.
Canavese F, Dimeglio A. Perthes disease: prognosis in children under six years of age. J Bone Joint Surg Br. 2008;90(7):940–5.
Schoenecker P, Stone J, Capelli A. Legg-Perthes disease in children under 6 years old. Orthop Rev. 1993;22(2):201–8.
Cowell C. Australian New Zealand Clinical Trials Registry: avascular Necrosis due to Perthes disease. 2009; cited 2015; Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335166
Herring J, Kim HT, Browne R. Legg-Calvé-Perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and Stulberg classification. J Bone Joint Surg Am. 2004;86(10):2103–20.
Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes’ disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. 2008;90-B(10):1364–71.
Nguyen N, Klein G, Dogbey G, McCourt JB, Mehlman CT. Operative versus nonoperative treatments for Legg-Calvé-Perthes disease: a meta-analysis. J Pediatr Orthop. 2012;32:697–705.
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Perry, D., Bodansky, D. (2017). What Is the Best Treatment for Perthes’ Disease?. In: Alshryda, S., Huntley, J., Banaszkiewicz, P. (eds) Paediatric Orthopaedics. Springer, Cham. https://doi.org/10.1007/978-3-319-41142-2_5
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