[Legg-Calvé-Perthes disease in early childhood: conservative versus surgical management : A risk-adapted containment approach].

backgroundEarly-onset Legg-Calvé-Perthes disease (LCPD) carries a favorable prognosis in the majority of cases; key determinants of outcome are adequate containment (acetabular coverage) of the femoral head and preservation of range of motion during the initial Waldenström stages. DECISION-MAKING: We present practical classifications and a treatment strategy that prioritizes conservative management and focuses operative interventions on "hips at risk." In children younger than approximately 6 years of age, treatment includes activity modification and dedicated ROM therapy. "Hip-at-risk" signs-particularly progressive decentering of the femoral head-identify the subgroup that benefits from early containment surgery. THERAPY: Proximal femoral varus osteotomy is technically straightforward and widely established; its limitations include limb-length discrepancy and potential worsening of an existing abductor weakness; in childhood, pelvic Tönnis triple osteotomy addresses containment most comprehensively in LCPD and, in experienced hands, can be performed with low morbidity and early mobilization. As a general principle, the procedure should be selected that most reliably restores containment for the individual hip and with which the treating center has the greatest expertise.

conclusionCentralization of care would be desirable to generate robust long-term data and guidelines for this-perhaps surprisingly-insufficiently standardized condition.