gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

A short history of knowledge on legg-cave-perthes disease

Meeting Abstract

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  • presenting/speaker Walter Michael Strobl - Clinic for Pediatric Orthopaedics, Rummelsberg – Nuremberg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO17-1153

doi: 10.3205/17dkou701, urn:nbn:de:0183-17dkou7015

Published: October 23, 2017

© 2017 Strobl.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: In spite of more than 100 years of research on Legg-Calvé-Perthes Disease (LCPD) its etiology, pathophysiologic pathways, causal treatment methods, and prognosis of individual outcome are still unclear. Healing without hip joint deformities as well as development of severe osteoarthritis are not exactly predictable. Recently, biologic, multi-center, and long-term research have enhanced our knowledge. Increasing evidence-approached understanding of physiologic and pathologic hip joint development have changed diagnostic and therapeutic algorithms. It effected earlier diagnostics, first biochemical treatment methods, modified movement and orthetic therapy, as well as new surgical ways of reducing the risk of severe joint deformities.

Goal of this study is reviewing and providing insight in recent understanding of pathophysiology of the disruption and repair processes that causes the typical course of LCPD and its therapeutic mechanisms.

Methods: Review of recent literature 2005-2016. Historical part: author's handbook contributions 1997 and 2004.

Results and Conclusion: Since its first description in 1910 LCPD is known as an idiopathic osteonecrosis of the femoral head. Over the past decades clinical and radiological observations enabled orthopaedic surgeons to define risk factors and classifications, conducting research regarding its causes produced several hematologic, anatomical, and mechanical hypotheses. Today LCPD is still regarded to be a challenge because of the unclear etiology as well as the controversial discussion about the role and kind of multiple treatment principles. Prognosis depends on clinical (e.g. age at onset, gender, hip joint ROM, body weight) and radiological parameters (extent of necrosis seen in MRI and x-rays, head lateralisation and containment). Recent treatment concepts focus on improving reduced range of motion, reducing vertical forces on the femoral head by partially immobilization and on improving containment of the head within the acetabulum. Additionally, treatment of early stages includes the biochemical enhancement of blood supply of the femoral head. The role of therapeutic treatment has mainly replaced the use of abduction splints and walking orthoses. Intertrochanteric varus osteotomies are combined with periacetabular osteotomies to improve containment of the femoral head and to reduce the biomechanic disadvantage of femoral shortening. Because of a high rate of spontaneous remissions without deformities on the one hand, and on the other hand significant risks of premature osteoarthritis with the need of early total hip replacement in both treatment groups, conservative and surgical concepts are still discussed controversially.