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Arthrodiatasis for the treatment of Perthes' disease
1Orthopedic Department, Tanta University Hospital, Tanta, Egypt. tahmed21@hotmail.com
Insights
Arthrodiatasis, a hip joint distraction technique, effectively treats early Legg-Calvé-Perthes disease in children under 8. This method improves femoral head height and containment, leading to better clinical and radiological outcomes compared to conservative treatment.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Biomechanical Engineering
Background:
- Legg-Calvé-Perthes disease involves femoral head osteonecrosis, often due to interrupted blood supply.
- Current treatments focus on containment to guide femoral head remodeling during fragmentation and ossification.
Purpose of the Study:
- To evaluate the efficacy of arthrodiatasis in restoring femoral head height and achieving non-weight-bearing containment.
- To compare outcomes of arthrodiatasis with conservative management in pediatric Perthes' disease.
Main Methods:
- A cohort of 42 patients under 8 with Perthes' disease (Herring's classification B or C) was studied.
- Twenty-three patients underwent arthrodiatasis (articulated distraction) with external fixators.
- Nineteen patients received conservative treatment as a control group.
Main Results:
- Arthrodiatasis yielded satisfactory radiological results in 91% and good clinical outcomes in 92% of patients.
- Conservative treatment showed satisfactory radiological results in 72% and good clinical outcomes in 71% of patients.
- Arthrodiatasis demonstrated superior outcomes, particularly in patients with reduced hip abduction.
Conclusions:
- Hip joint containment via articulated arthrodiatasis is an effective treatment for Perthes' disease (B/C) in young children.
- This technique restores clinical function and radiological parameters effectively.
- Arthrodiatasis offers significant advantages over conservative management for specific Perthes' disease classifications.
Abstract:
It is hypothesized that the interruption of the blood supply is an important factor causing femoral head osteonecrosis in the early stages of Legg-Calvé-Perthes disease. Currently, treatment by containment is recommended to direct and guide remodeling of the softened femoral head as it evolves from fragmentation through ossification. The goal of this study was to show the results of arthrodiatasis to induce height recovery of the femoral head and to achieve true ambulatory nonweight-bearing containment. Forty-two patients younger than 8 years with a diagnosis of Perthes' disease were studied. Twenty-three patients (9 class B and 14 class C according to Herring's classification) were treated with an articulated distraction technique and 19 patients (11 class B and 8 class C) were treated conservatively as a control group. Arthrodiatasis or articulated distraction of the hip combines off-loading of muscles and body forces with distraction of the joint space by means of an external fixator that crosses the hip joint. Radiologically, 21 patients (91%) had satisfactory results and 2 (9%) had unsatisfactory results. Clinically, the results were good in 21 patients (92%), fair in 1 (4%), and poor in 1 (4%). In patients treated conservatively, 14 patients (72%) had satisfactory results and 5 (28%) had unsatisfactory results. Clinically, 71% had good results, 17% had fair, and 12% had poor. We conclude that hip joint containment by articulated arthrodiatasis (plus adductors and psoas minimal tenotomy surgery) is an effective method in the management of Perthes' disease in patients younger than 8 years, classified B and C, and associated with a highly reduced range of abduction. Restoration of clinical abnormalities and satisfactory radiological parameters are achieved in high percentages.
