Comparison of abduction brace and surgical containment in management of Perthes disease

Abstract

Abstract The approach in management of Perthes disease attempts to prevent the femoral head from bearing forces across the acetabular margin by either preventing or reversing extrusion of the femoral head. Once the diagnosis is established, the primary aim of treatment of Legg-Calve-Perthes disease is containment of femoral head within the acetabulum. Containment can be achieved either conservatively or surgically. If this is achieved, the femoral head can reform in a concentric manner by what Salter has termed as “biological plasticity”. Thirty-six patients with Perthes disease were thoroughly evaluated both clinically and radiologically following admission and were divided into 2 groups in a randomized trial. Eighteen patients in group I received conservative treatment with a weight-relieving caliper, a modification of ambulation-abduction brace designed in our institute. Equal number of patients in group II were treated by surgical methods to bring the subluxated head inside the acetabulum for containment. Of the 18 patients in group II, 9 patients were undergone Axer's osteotomy and another 9 patients were treated by trochanteric bifurcation osteotomy with lateral advancement of trochanter and the bifurcation is maintained by autogenous ipsilateral fibular graft. The follow-up period is 2 years. We lost follow-up of 1 patient in group I, 1 from Axer's osteotomy, and 3 from trochanteric advancement group. Another 5 patients in group III were not treated but followed up similar to groups I and II in this study. It is evident from the overall result of different groups that 64% of good results were observed in group I, followed by group II (50%) and group III (20%). Fair results were observed at 50% in group II, followed by group III (40%) and group I (18%). There was no evidence of poor results in group II, whereas it was 40% in group III and 20% in group I. Our maximum percentage of good results was observed in the conservative group and in the untreated group the percentage of good results is as low as 20%. Fair results were almost the same in all 3 groups, irrespective of type of treatment. Clinical and radiological outcome in both conservative and surgical containment group is similar, although the Axer's osteotomy group has an extra burden of shortening and limping, and requires a second surgery for plate removal.