Legg-Calvé-Perthes disease: Results of discontinuing treatment in the early reossification phase

The major controversy in Legg-Calvé-Perthes disease concerns its treatment. All authors recognize the need for containment of the femoral head but do not agree on the method of containment. Surgical containment is constant, does not require an endpoint for discontinuing treatment and has a short treatment period. Conservative treatment, however, produces comparable results, avoids operative and anesthetic complications but requires prolonged immobilization. The concept of Ferguson and Howorth can be validated and indicates that when early subchondral reossification is present on both the anteroposterior and lateral roentgenograms that conservative containment treatment can be safely discontinued thus shortening outpatient time to 12 months or less. The results of 165 hips undergoing conservative treatment and 27 who received surgery are analyzed. Eighty-one conservatively treated hips were mobilized early and followed for an average of 5 years. Their results were identical to those treated until the time of complete restoration of the capital femoral epiphysis. This reduction in outpatient treatment and the decrease in potential complications minimizes several of the major arguments in favor of surgical management.