Legg-Calvé-Perthes disease.

A new treatment protocol has been developed at the Alfred I. duPont Institute by an evaluation of 480 hips affected with Legg-Calvé-Perthes disease. One hundred fifty hips have been followed up to skeletal maturity and show deformities of coxa magna (58%), coxa brevis (21%), coxa irregularis (18%), and osteochondritis dissecans (3%). Treatment is prescribed using a new classification--Class I: predeformed epiphysis (200 hips), for which treatment is needed if the patient is older than six years of age or has greater than 50% epiphyseal necrosis; Class II: deformed epiphysis prior to reossification (134 hips), for which treatment by containment is recommended; Class III: reossification (83 hips), for which reconstructive procedures may be considered if the patient is younger than seven years of age; and Class IV: mature/maturing (28 hips), in which the patients have symptoms of leg-length discrepancy, trochanteric overgrowth, osteochondritis dissecans, and degenerative joint disease. Analysis of containment methods in 192 hips reveals that Petri casts (69), Scottish Rite orthosis (44), the AIDI brace (15), varus osteotomy (34), and innominate osteotomy (30) produce comparable results.