Floor Level Activity as a Sign of Congruency and Containment in Perthes’ Disease

Abstract

Background: This study aims to note the role of floor level activities like squatting and sitting cross-legged as the indicator of healing with good containment and congruency in Perthes’ disease in children below eight years of age. The research hypothesis of the study is that the functional outcome of the affected hip joint in the form of spontaneous, free and full painless floor level activity in day to day life of the child is a better indicator of outcome irrespective of the radiographic changes in the hip joint. Subjects and Methods: A retrospective observational study was conducted in a tertiary care university hospital. The study included all the patients diagnosed with Perthes’ disease whose last radiological assessment showed signs of healing. Patients above eight years and patients who had not started showing radiological healing were excluded. Parameters assessed were the presence of lurch, pain at the hip joint, limb length discrepancy, range of motion at the hip joint and ability to sit cross-legged and squat and epiphyseal extrusion index on radiographs. Results: Nineteen hips in 18 patients met criteria with a mean age of 7.1 1.5 years at presentation with a minimum follow-up of 30 (30 – 72) months. None of the patients had any residual lurch or tenderness at the hip joint at final follow up and all were able to sit cross-legged and squat symmetrically and comfortably with significant improvement of motion at the hip joint (p<0.05). No correlation was noted among the clinical and radiological features; except the internal rotation at healing with epiphyseal extrusion index at healing. Conclusion: Clinical function holds the key primarily in the course of treatment of Legg-Calve-Perthes’ disease. Conservative management in the form of bracing, floor level activities, and hip flexion and abduction exercises lead to congruency and containment in Legg-Calve-Perthes’ disease up to the age of eight years.