Legg-Calvé-Perthes syndrome physical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical Therapy
The goal of treatment is to avoid severe degenerative arthritis. Orthopedic assessment is crucial. Younger children have a better prognosis than older children. There are no drugs for treatment of Perthes. Analgesic medication may be given as necessary.
Treatment has traditionally centered on removing pressure from the joint until the disease has run its course. Options have included bed rest and traction (to separate the femur from the pelvis and reduce wear), often for several months or even years. Braces and plaster casts were also popular, again to isolate the joint. Recent evidence suggests that these methods are not effective, and treatment seems to be moving towards a mixture of careful monitoring, physiotherapy, and surgical intervention when necessary. For older children, the distraction method been found to be a successful treatment by using an external fixator which relieves the hip from carrying the body's weight. This allows room for the top of the femur to regrow and shape better.
Modern treatment focuses on removing pressure from the joint in concert with physiotherapy. Pressure is minimized on the hip through use of crutches or a cane, and the avoidance of running-based sports. Swimming is highly recommended - it allows exercise of the hip muscles with the full range of motion, while reducing the stress to a minimum. Physiotherapy treatment generally involves a daily series of exercises, with weekly meetings with a physiotherapist to monitor progress. These exercises focus on improving and maintaining a full range of motion of the femur within the hip socket. Performing these exercises during the healing process is essential to ensure that the femur and hip socket have a perfectly smooth interface. This will minimize the long term effects of the disease.
Perthes is a long-term problem - treatment is aimed at minimizing damage while the disease runs its course, not at 'curing' the disease. As sufferers age problems in the knee and back can arise, as a result of the abnormal posture and stride adopted to protect the affected joint. The condition is also linked to arthritis of the hip and other joints, though this appears not to be an inevitable consequence.