Perthes Disease, Results of Conservative Management at Soba University Hospital

Abstract

Background: Legg-Calve- Perthes’ Disease (LCPD) is an idiopathic avascular necrosis of the femoral head. It affects children between four and 10 years. Male : female ratio of 4:1. The main aim of treatment is to get an acceptable containment of a spherical head with good range of motion. Ideal way of treatment remains controversial.

Objectives: To study patterns of presentations and outcome of management of patients with LCPD treated at Soba University Hospital.

Materials and Methods: Records of patients with LCPD who were treated at Soba
University Hospital between 2005 and 2013 were reviewed. There were 43 patients (46 hips). Their patterns of presentation, follow up notes and imaging as well as clinical and radiological outcome were reviewed.

Results: There were 43 patients 29 Males and 14 females (2:1) with 46 hips. Their ages ranged between 4 and 12 years (mean 7.7). 74.4% of patients were from low socioeconomic strata of the society. 9.3% of patients had family history and 58.1% had history of trauma. Painless limp was the presenting complaint in 88.4%. Herring lateral pillar classification was used; 43.5%) group A, 37.0% B, 13.0% B/C and 6.5% C. Thirty four hips (73.9%) had conservative treatment using Ischial Weight Bearing Calliper and physiotherapy in Lotus (Fagir) sitting Position and 12 hips (26.1%) had surgical treatment. Thirty one hips (67.4%) of those who were treated conservatively healed with Stulberg I or II, while 7 hips (58%) of those who underwent surgery with Stulberg I or II. Most of patients who presented at age less than 6 years healed with Stulberg I or II.

Conclusion: LCPD affects children of low class. Prognosis is generally good when the age at onset less than 6 years. Herring’s lateral pillar classification is a reliable method of classification. Conservative treatment using Ischial Weight Bearing Calliper and physiotherapy in Lotus (Fagir) sitting Position has good outcome.

Keywords: Perthes’ Disease, Conservative Management, Soba.