Conservative treatment of Legg-Calvé-Perthes condition.

As we continue to learn more about the evolution of Legg-Calvé-Perthes condition, several advantages to early conservative treatment become apparent. First, since it may take as long as 6 months to determine the extent of femoral head involvement in patients who present early in the disease process, nonoperative methods may be used to improve the range of motion and to contain the femoral head within the acetabulum, thus minimizing further deformity. Second, since the duration of treatment need no longer be as extensive as was previously thought, the argument that nonoperative means are unrealistic for patient needs is not valid. Finally, it has been recognized that with moderate sphericity and moderate retention of the shape of the femoral head, as evaluated in relationship to secondary changes in the acetabulum, the patient can reach at least middle age before having significant secondary arthritic problems. A relatively conservative approach is therefore in order for most children whose disease is discovered in the early phases. Of course, it must be recognized that social problems develop in the older child, especially in girls, that contraindicate nonoperative care. Surgical considerations are indicated for many children in the older age group with more than one half of the femoral head involved, as well as in those with unsuccessful nonoperative efforts at containment.