The treatment of Legg-Calvé-Perthes disease. To contain or not to contain.

In order to evaluate a treatment protocol involving a non-containment method and femoral osteotomy when lateral subluxation of the femoral head develops, 39 children with 42 affected hips were examined radiologically an average of 7 years (4-16 10/12) following the onset of Legg-Calvé-Perthes disease. Twenty-six hips were treated conservatively with an ischial-bearing, Thomas-type splint and 16 with a femoral varus derotating osteotomy. Both Catterall and Herring gradings were used. The end result was evaluated according to the Stulberg classification. All Catterall grade I (n = 8) hips had a satisfactory result regardless of age at onset and method of treatment. In Catterall groups II-IV (n = 34), age at onset influenced the treatment outcome. In children affected before the age of 8 years, results of conservative treatment were originally satisfactory but were seen to deteriorate with advancing age. In children over 8 years old (n = 13), the results clearly favour operative containment.