Legg-Perthes Resonses

Legg-Perthes Resonses

Thank you all for your responses. As you can see a consensus does not appear
to exist.

God Bless

Don McGovern,CPO

I worked at a Children's Hospital in South Dakota as an CO for the last 6
1/2 years. I had referrals from a young orthopedist
for Legg-Perthes. Nowdays they pretty much brace only for symptom relief or
post-op if cases extreme in severity where they had to intervene surgically
(rare). Then he used the Scottish Rite orthosis (Atlanta orthosis). The
only kids that usually needed symptom relief were total head involvement.
Legg-Perthes often causes a leg length discrepency though and I would get Rx
for heel lift only for some of the kids.

Carrie Beets, CO
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While I was at Newington Children's Hospital ('93-'97) the use of orthoses
for management of LCP were limited to those cases where the parents refused
surgical intervention. When used, the orthosis of choice was the Scottish
Rite.

It is my understanding that orthotic management is not as effective as
surgery, and the orthosis must be worn for 12-18 months while LCP runs its
course. The surgical treatment (varus derotation osteotomy of the femoral
neck) positions the femoral head in the acetabulum more appropriately and in
6-8 weeks the child can resume (nearly) normal activities.

Obviously, one must compare the very real risks associated with surgery to
the inconvenience of an orthosis and the potential for a poor outcome.

I have not read the following, but it may be of interest.

TITLE: A comparative study of ambulation-abduction bracing and varus
derotation osteotomy in the treatment of severe Legg-Calve-Perthes disease
in children over 6 years of age.
AUTHORS: Evans IK, et al.
SOURCE: J Pediatr Orthop. 1988 Nov-Dec;8(6):676-82.

It seems to me that there has been some more recent research done on this,
but I am unable to locate it at this time.


Good luck,
Robert N. Brown, MS, CPO
Clinical Director of Orthotics and Prosthetics
University of Rochester Medical Center

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For the last few years, 10 or so, the latest orthopedic thinking has been to
do nothing. Abduction of the hip joint didn't seem to speed repair. The
only thing that has been done to warn against heavy pounding of the joint
such as distance jogging or contact sports. The femoral head seemed to do
quite well under normal conditions and light exercise. So with the
combination of monitoring and not to much abuse it's been felt that the child
shouldn't be put through the trauma of orthotic treatment.

Anything else just write.

Take care.

Evan A. Bader, MD, CPO, FAAOP

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I think you should try to find something with the French community.Here the
physicians are doing the same but last year on a
Congress , a French doctor told us that they used to do that in French and
they had a terrible outcome with some kids ending with
serious acetabular and femur head`s deformities.Try to contact some French
orthotists and see what they can find for you.
I personally prefer to still use the Atlanta brace and in 14 years practice I
have never been a kid become worse with this orthoses.

Sincerely,

Mario Cesar Carvalho
Biomedical engineer-Orthetist
Rio de janeiro-BRAZIL

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I had the disease bilaterally and I didn't walk for five years while I
remained in abduction braces. I'm fine now. Is it bilateral or unilateral?
I would suggest a second opinion at the very least and Scottish rite hip
abduction orthoses if it were my kid. I would not accept nonintervention, as
that is the type of thing that a true surgeon would say.

ERIC TOSKY, C.O.

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