Legg-Calve-Perthes Disease in Emergency Medicine Follow-up
- Author: Jessica Hernandez, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Further Outpatient Care
Legg-Calvé-Perthes disease does not require emergent inpatient care.
Treatment may involve observation, usually in children younger than 6 years.
Surgical treatment may benefit older patients; however, the ability of surgical treatment to achieve a normal hip at maturity is modest.[2, 17]
Bed rest and abduction stretching exercises are recommended.
Nonsurgical containment allows the femoral head to stay within the acetabulum, where it can be molded. Various casts, braces, and crutches have been used for containment.
Initially, close follow-up is required to determine the extent of necrosis.
Once the healing phase has been entered, follow-up can be every 6 months.
Long-term follow-up is necessary to determine the final outcome.
Surgical correction of gross deformities of the femoral head may be necessary. Recent studies have demonstrated that patients aged 6 years or older treated conservatively fared worse than those treated with surgery.
In contradistinction, other studies show that surgical management in younger children does not improve long-term outcome.[12, 18, 19]
Legg-Calvé-Perthes disease may result in femoral head deformity and degenerative joint disease. The femoral head may be distorted permanently.
The younger the age of onset of Legg-Calvé-Perthes disease, the better the prognosis. Children older than 10 years have a very high risk of developing osteoarthritis. Most patients have a favorable outcome. Prognosis is proportional to the degree of radiologic involvement.[19, 10, 20]
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