Treatment of Legg-Calvé-Perthes Disease of the Hip by Joint Distraction

Abstract

Unloading of the hip was originally considered important in the treatment of Perthes disease. However, various methods of unloading were unsuccessful in altering the natural history of the disease. This may have been due to the misconception that non-weight bearing and unloading were equivalent. To truly remove the compressive forces from the hip, muscular forces must be neutralized. This can be accomplished by hip joint distraction with an external fixator. It was postulated that if the femoral head could be distracted back into the acetabulum, the epiphyseal cartilage would proliferate to fill the gap between the collapsed femoral head and the acetabulum, and improved range of motion could be expected. Surgical techniques and postoperative management of hip joint distraction for treatment of Perthes disease are described in detail. Clinically, patients who had hip joint distraction were active and had little gait abnormality, pain, or weakness after treatment.