Is conservative treatment really effective for Legg-Calvé-Perthes disease? A critical review of the literature.

INTRODUCTION

The treatment of Legg-Calvé-Perthes Disease (LCPD) is controversial and not well defined. This literature review aimed to assess the quality of the evidence available to support the effectiveness of conservative LCPD treatment advocated by orthopaedic surgeons and(or) paediatricians. A secondary aim was to see if conservative treatments really modify the natural history of LCPD.

MATERIALS AND METHODS

The review was performed mainly on the PubMed Database and based on the principles of Evidence Based Practice (EBP). Keywords used were Perthes disease, conservative treatment, containment treatment, review, and weight-relief. EBP is the integration of the best research evidence with clinical expertise and patient values of which there are five different levels of evidence: (1) Randomized Controlled Trials; (2) Prospective Cohort Study; (3) Case Control or Retrospective Cohort Study;(4) Case Series; 5) Expert Opinion or Individual Case Report. Results. Until 20th August 2005 there were 144 articles of clinical relevance about conservative treatment of LCPD: 16.7% of EBP level 5; 50.7% of level 4; 31.9% of level 3; none of level 2; and 0.7% of level 1.

CONCLUSION

The quality of evidence that supports conservative treatment for children with LCPD is not of high quality. There is no scientific evidence that conservative treatments modify LCPD natural history. Containment, no containment and simple symptomatic treatment have comparable effectiveness. Prolonged weight-relief and(or) containment treatments are associated with social and psychological problems.