A Femoral Head Start

Abstract

We have been taught that Legg-Calve-Perthes disease usually results in femoral head deformity because collapse within the area of bone necrosis occurs before new bone formation gives adequate support. During our training, we were exposed to a number of strategies to avoid loss of femoral head sphericity. Mechanical treatments included non-weight-bearing, bed rest, a variety of braces, and traction. Most surgical approaches were reserved for older children. We were taught that with proper femoral head coverage and force protection, creeping substitution would be more likely to gradually replace dead bone with new living bone before severe deformity occurred1. The article by Kim et al. describes a piglet model for investigating weight-bearing (WB) compared with non-weight-bearing (NWB) management. A hind-limb amputation above the knee was necessary to make the animal non-weight-bearing. With the animal forced into non-weight-bearing, compliance was not an issue. The piglets were the age equivalent of a four to five-year-old child. Humans usually develop Legg-Calve-Perthes disease after that age, and younger children do better than those who are …