Rambam Hospital Protocol for Treatment of Early Stages of Legg-Calve-Perthes Disease

Abstract

The treatment of Leg-Calve-Perthes Disease (LCPD) is an orthopedic enigma without consensus in the literature. Despite all efforts, coxa breva with overgrowth of the greater trochanter (GT) is commonly present in many patients. In 2013, we introduced a protocol that included transepiphyseal drilling of the femoral head, closure of the GT, adductor tenotomy, and 4 months of non–weight-bearing on the affected leg. The purpose of this study was to evaluate midterm results in patients treated by our protocol. Over 11 years, we treated 31 patients with LCPD. Average age was 7.1 (range 5 to 10) years. We divided all patients into 2 groups: group A included 18 patients in early fragmentation stage, group B contained 12 patients in late fragmentation and one in reossification stage. All patients underwent the same treatment protocol as described. Mean follow-up was 52 months. All patients had a limp before surgery. At the latest follow-up, 22 had no limp, and 23 had substantial improvement in hip range of motion. In group A, 12 patients had Stulberg type 1, 5 Stulberg 2, and 1 Stulberg type 3. In group B, 1 patient had Stulberg type 2, 9 patients had Stulberg type 4, and 3 patients had Stulberg type 5. On the basis of our experience, the proposed protocol can be effective in the treatment of the early fragmentation stage of LCPD.