The role of bracing in Legg-Calve-Perthes disease.

BACKGROUND

Treatment methods in Legg-Calve-Perthes disease (LCPD) have varied during the 100-year history of this disorder. This is a review of the present practice of bracing in LCPD.

METHODS

Published articles from the last 35 years were reviewed including primary analyses of bracing, meta-analysis, and summaries of present opinion. The recent literature was also evaluated to determine the present bracing practices.

RESULTS

Studies performed regarding specific braces failed to show that they offer any advantage over other methods of management, including no treatment. Similarly, meta-analyses showed that hips treated with nonoperative containment had little difference in outcome based on present methods of analysis. Opinion papers suggested that the use of braces in LCPD should be significantly decreased or discontinued altogether. There is a major controversy regarding weaning and discontinuation of bracing. The use of Petrie casts can be considered in "salvage" techniques of hips with subluxation or hinged abduction.

CONCLUSIONS

The present literature does not provide evidence sufficient to support the use of bracing in LCPD. On the basis of this review, our recommendation is that the abduction orthosis should rarely be used in the treatment of LCPD. Petrie casts still have a role in short-term treatment in patients with deformed femoral heads before complete reossification.