Orthopadie (Heidelberg, Germany) · 2026
[Legg-Calvé-Perthes disease in early childhood: conservative versus surgical management : A risk-adapted containment approach].
СтатьяОбзорАннотация на английскомСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Wagner Ferdinand, Endres Felix
Аннотация
BACKGROUND: Early-onset Legg-Calvé-Perthes disease (LCPD) carries a favorable prognosis in the majority of cases; key determinants of outcome are adequate containment (acetabular coverage) of the femoral head and preservation of range of motion during the initial Waldenström stages.
DECISION-MAKING: We present practical classifications and a treatment strategy that prioritizes conservative management and focuses operative interventions on "hips at risk." In children younger than approximately 6 years of age, treatment includes activity modification and dedicated ROM therapy. "Hip-at-risk" signs-particularly progressive decentering of the femoral head-identify the subgroup that benefits from early containment surgery.
THERAPY: Proximal femoral varus osteotomy is technically straightforward and widely established; its limitations include limb-length discrepancy and potential worsening of an existing abductor weakness; in childhood, pelvic Tönnis triple osteotomy addresses containment most comprehensively in LCPD and, in experienced hands, can be performed with low morbidity and early mobilization. As a general principle, the procedure should be selected that most reliably restores containment for the individual hip and with which the treating center has the greatest expertise.
CONCLUSION: Centralization of care would be desirable to generate robust long-term data and guidelines for this-perhaps surprisingly-insufficiently standardized condition.
DECISION-MAKING: We present practical classifications and a treatment strategy that prioritizes conservative management and focuses operative interventions on "hips at risk." In children younger than approximately 6 years of age, treatment includes activity modification and dedicated ROM therapy. "Hip-at-risk" signs-particularly progressive decentering of the femoral head-identify the subgroup that benefits from early containment surgery.
THERAPY: Proximal femoral varus osteotomy is technically straightforward and widely established; its limitations include limb-length discrepancy and potential worsening of an existing abductor weakness; in childhood, pelvic Tönnis triple osteotomy addresses containment most comprehensively in LCPD and, in experienced hands, can be performed with low morbidity and early mobilization. As a general principle, the procedure should be selected that most reliably restores containment for the individual hip and with which the treating center has the greatest expertise.
CONCLUSION: Centralization of care would be desirable to generate robust long-term data and guidelines for this-perhaps surprisingly-insufficiently standardized condition.