Comparative study of Perthes' disease treated by various ambulatory orthoses

Ninety-six hips of 90 patients treated by three different orthoses, Thomas type, Tachdjian type and Atlanta type, were radiologically and clinically surveyed to evaluate the containment effect and the influence of weight-bearing. The Tachdjian and Atlanta types which introduced the containment method yielded good or fair results in 69% and 77% of cases respectively--clearly higher than the 52% with the Thomas type which only relieved weight-bearing. Comparison of the results between the Tachdjian type with non weight-bearing and the Atlanta type with weight-bearing, no significant difference was found but the latter had some advantages in terms of improved hip abduction, ease of movement and fit. Therefore, we are encouraged to continue the use of the Atlanta type for ambulatory orthotic treatment of the Perthes' disease. However, the rate of poor results could be expected in about 20% to 30% even in the Atlanta type. Another type of treatments should be chosen for the patient in whom the poor result is anticipated with our protocol.