From the Guidelines
For patients with Legg-Calvé-Perthes disease, deferring clinic visits for up to three months may be necessary during the COVID-19 pandemic to minimize the risk of viral transmission, as the risks of deferring treatment must be weighed against the risks of continuing treatment as usual during the crisis. Considering the current pandemic situation, the management of Legg-Calvé-Perthes disease should prioritize minimizing exposure to potential vectors of viral transmission, while also considering the potential long-term impact of delayed treatment 1. Key aspects of treatment include:
- Observation with activity modification and physical therapy for mild cases in younger children (under 6 years)
- Containment methods, such as bracing or surgical interventions, for moderate to severe cases, especially in older children
- Pain management with NSAIDs like ibuprofen or naproxen
- Physical therapy to maintain hip range of motion and strength It is essential to weigh the risks and benefits of treatment during the pandemic, taking into account the unique features of pediatric care, such as the number of caregivers and healthcare workers involved in each clinic visit, which increases the chance of spreading infection 1. Regular follow-up with orthopedic specialists is crucial to monitor hip development and adjust treatment as needed, although this may need to be done through alternative means, such as telemedicine, during the pandemic.
From the Research
Perthes Disease Overview
- Perthes disease is a condition that affects the hip joint, causing pain and disability in adults with a history of the disease 2.
- The disease can lead to necrosis of the femoral head, and its management typically includes non-surgical treatment options, such as physiotherapy, with or without surgical intervention 3.
Treatment Options
- Surgical treatment may relieve pain and disability in adults with a history of Perthes' disease, and may involve procedures such as arthrotomy, valgus osteotomy, and lateral displacement of the great trochanter 2.
- Non-surgical interventions, such as orthotic management and physical interventions like muscle strengthening or stretching, have been used to treat Perthes disease, but there is limited evidence on their effectiveness 3.
- Conservative treatment, including non-weight bearing, abduction casts, orthoses, and rehabilitation, has been shown to have limited success in improving long-term outcomes, with only 25% of evaluated hips being normal 20 years after onset 4.
Surgical Interventions
- Surgical hip dislocation and relative femoral neck lengthening have been used to treat sequelae of Perthes disease, with improvements in hip biomechanics and clinical function 5.
- Acetabular reorientation techniques, such as triple osteotomy, have been favored in recent years, as they do not impair biomechanical relations like femoral varus osteotomy 6.
Outcome Measures
- Radiological scores, such as Stulberg and Mose, have been used to evaluate the effectiveness of treatment options, with poor scores indicating limited hip function and increased risk of osteoarthritis 4, 3.
- Functional measures, such as range of movement, and patient-reported outcomes, such as health-related quality of life, have also been used to assess treatment outcomes 3.