Skip to main content
main-content
Erschienen in: Der Orthopäde 12/2013

01.12.2013 | Leitthema

Aktuelle Behandlungsstrategie des Morbus Perthes

verfasst von: B. Westhoff, F. Martiny, Prof. Dr. R. Krauspe

Erschienen in: Die Orthopädie | Ausgabe 12/2013

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Langzeitprognose nach Morbus Perthes wird bestimmt von der Sphärizität des Hüftkopfs und von der Kongruenz des Gelenks nach Ausheilung. Zahlreiche Faktoren, die Auswirkungen auf das Ausheilungsergebnis haben, sind bekannt, aber von diesen können lediglich die „Gelenkbeweglichkeit“ und das Containment therapeutisch beeinflusst werden. Durch unterschiedliche konservative Maßnahmen soll die Gelenkbeweglichkeit erhalten bzw. wiederhergestellt und die auf das Hüftgelenk wirkenden deformierenden Kräfte reduziert werden. Bei Verlust des Containments sind operative Maßnahmen – möglichst im frühen Fragmentationsstadium – indiziert. Dabei sind aus biomechanischen Gründen pfannenkorrigierende Eingriffe zu bevorzugen. Bei einem Alter von < 8,5 Jahren ist zur Prophylaxe eines Trochanterhochstands eine Trochanterapophyseodese zu erwägen. Die Ergebnisse containmentverbessernder Operationen sind ermutigend. Therapeutisch problematisch bleibt jedoch der schwere Morbus Perthes bei älteren Kindern – hier sind die Ergebnisse bislang weniger erfolgversprechend.
Literatur
1.
Zurück zum Zitat Bergmann G, Correa da Silva M, Neff G et al (1994) Evaluation of ischial weight-bearing orthoses, based on in-vivo hip joint force measurements. Clin Biomech 9:225–234 CrossRef Bergmann G, Correa da Silva M, Neff G et al (1994) Evaluation of ischial weight-bearing orthoses, based on in-vivo hip joint force measurements. Clin Biomech 9:225–234 CrossRef
2.
Zurück zum Zitat Brech GC, Guarnieiro R (2006) Evaluation of physiotherapy in the treatment of Legg-Calve-Perthes disease. Clinics (Sao Paulo) 61:521–528 Brech GC, Guarnieiro R (2006) Evaluation of physiotherapy in the treatment of Legg-Calve-Perthes disease. Clinics (Sao Paulo) 61:521–528
3.
Zurück zum Zitat Green NE, Beauchamp RD, Griffin PP (1981) Epiphyseal extrusion as a prognostic index in Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 63:900–905 Green NE, Beauchamp RD, Griffin PP (1981) Epiphyseal extrusion as a prognostic index in Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 63:900–905
4.
Zurück zum Zitat Hardesty CK, Liu RW, Thompson GH (2011) The role of bracing in Legg-Calve-Perthes disease. J Pediatr Orthop 31:S178–S181 PubMedCrossRef Hardesty CK, Liu RW, Thompson GH (2011) The role of bracing in Legg-Calve-Perthes disease. J Pediatr Orthop 31:S178–S181 PubMedCrossRef
5.
Zurück zum Zitat Hefti F (2006) Kinderorthopädie in der Praxis. Springer, Berlin Heidelberg New York Hefti F (2006) Kinderorthopädie in der Praxis. Springer, Berlin Heidelberg New York
6.
Zurück zum Zitat Hefti F, Clarke NM (2007) The management of Legg-Calve-Perthes‘ disease: is there a consensus?: a study of clinical practice preferred by the members of the European Paediatric Orthopaedic Society. J Child Orthop 1:19–25 PubMedCentralPubMedCrossRef Hefti F, Clarke NM (2007) The management of Legg-Calve-Perthes‘ disease: is there a consensus?: a study of clinical practice preferred by the members of the European Paediatric Orthopaedic Society. J Child Orthop 1:19–25 PubMedCentralPubMedCrossRef
7.
Zurück zum Zitat Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg [Am] 86-A:2121–2134 Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg [Am] 86-A:2121–2134
8.
Zurück zum Zitat Hosalkar H, Munhoz da Cunha AL, Baldwin K et al (2012) Triple innominate osteotomy for Legg-Calve-Perthes disease in children: does the lateral coverage change with time? Clin Orthop Relat Res 470:2402–2410 PubMedCentralPubMedCrossRef Hosalkar H, Munhoz da Cunha AL, Baldwin K et al (2012) Triple innominate osteotomy for Legg-Calve-Perthes disease in children: does the lateral coverage change with time? Clin Orthop Relat Res 470:2402–2410 PubMedCentralPubMedCrossRef
9.
Zurück zum Zitat Hosny GA, El-Deeb K, Fadel M et al (2011) Arthrodiastasis of the hip. J Pediatr Orthop 31:S229–S234 PubMedCrossRef Hosny GA, El-Deeb K, Fadel M et al (2011) Arthrodiastasis of the hip. J Pediatr Orthop 31:S229–S234 PubMedCrossRef
10.
Zurück zum Zitat Hsu JE, Baldwin KD, Tannast M et al (2012) What is the evidence supporting the prevention of osteoarthritis and improved femoral coverage after shelf procedure for Legg-Calve-Perthes disease? Clin Orthop Relat Res 470:2421–2430 PubMedCentralPubMedCrossRef Hsu JE, Baldwin KD, Tannast M et al (2012) What is the evidence supporting the prevention of osteoarthritis and improved femoral coverage after shelf procedure for Legg-Calve-Perthes disease? Clin Orthop Relat Res 470:2421–2430 PubMedCentralPubMedCrossRef
11.
Zurück zum Zitat Joseph B, Nair NS, Narasimha Rao K et al (2003) Optimal timing for containment surgery for Perthes disease. J Pediatr Orthop 23:601–606 PubMedCrossRef Joseph B, Nair NS, Narasimha Rao K et al (2003) Optimal timing for containment surgery for Perthes disease. J Pediatr Orthop 23:601–606 PubMedCrossRef
12.
Zurück zum Zitat Kallio P, Ryoppy S (1985) Hyperpressure in juvenile hip disease. Acta Orthop Scand 56:211–214 PubMedCrossRef Kallio P, Ryoppy S (1985) Hyperpressure in juvenile hip disease. Acta Orthop Scand 56:211–214 PubMedCrossRef
13.
Zurück zum Zitat Kim HK (2012) Pathophysiology and new strategies for the treatment of Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 94:659–669 Kim HK (2012) Pathophysiology and new strategies for the treatment of Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 94:659–669
14.
Zurück zum Zitat Kim HK, Aruwajoye O, Stetler J et al (2012) Effects of non-weight-bearing on the immature femoral head following ischemic osteonecrosis: an experimental investigation in immature pigs. J Bone Joint Surg [Am] 94:2228–2237 Kim HK, Aruwajoye O, Stetler J et al (2012) Effects of non-weight-bearing on the immature femoral head following ischemic osteonecrosis: an experimental investigation in immature pigs. J Bone Joint Surg [Am] 94:2228–2237
15.
Zurück zum Zitat Kitakoji T, Hattori T, Iwata H (1999) Femoral varus osteotomy in Legg-Calve-Perthes disease: points at operation to prevent residual problems. J Pediatr Orthop 19:76–81 PubMed Kitakoji T, Hattori T, Iwata H (1999) Femoral varus osteotomy in Legg-Calve-Perthes disease: points at operation to prevent residual problems. J Pediatr Orthop 19:76–81 PubMed
16.
Zurück zum Zitat Kitakoji T, Hattori T, Kitoh H et al (2005) Which is a better method for Perthes‘ disease: femoral varus or Salter osteotomy? Clin Orthop Relat Res 163–170 Kitakoji T, Hattori T, Kitoh H et al (2005) Which is a better method for Perthes‘ disease: femoral varus or Salter osteotomy? Clin Orthop Relat Res 163–170
17.
Zurück zum Zitat Leclerc J, Laville JM, Salmeron F (2006) La traction au lit dans le traitement de la maladie de Legg-Perthes-Calvé. Rev Chir Orthop Reparatrice Appar Mot 92:741–745 PubMedCrossRef Leclerc J, Laville JM, Salmeron F (2006) La traction au lit dans le traitement de la maladie de Legg-Perthes-Calvé. Rev Chir Orthop Reparatrice Appar Mot 92:741–745 PubMedCrossRef
18.
Zurück zum Zitat Little DG, Kim HK (2011) Potential for bisphosphonate treatment in Legg-Calve-Perthes disease. J Pediatr Orthop 31:S182–S188 PubMedCrossRef Little DG, Kim HK (2011) Potential for bisphosphonate treatment in Legg-Calve-Perthes disease. J Pediatr Orthop 31:S182–S188 PubMedCrossRef
19.
Zurück zum Zitat Meehan PL, Angel D, Nelson JM (1992) The Scottish Rite abduction orthosis for the treatment of Legg-Perthes disease. A radiographic analysis. J Bone Joint Surg [Am] 74:2–12 Meehan PL, Angel D, Nelson JM (1992) The Scottish Rite abduction orthosis for the treatment of Legg-Perthes disease. A radiographic analysis. J Bone Joint Surg [Am] 74:2–12
20.
Zurück zum Zitat Nguyen NA, Klein G, Dogbey G et al (2012) Operative versus nonoperative treatments for Legg-Calve-Perthes disease: a meta-analysis. J Pediatr Orthop 32:697–705 PubMedCrossRef Nguyen NA, Klein G, Dogbey G et al (2012) Operative versus nonoperative treatments for Legg-Calve-Perthes disease: a meta-analysis. J Pediatr Orthop 32:697–705 PubMedCrossRef
21.
Zurück zum Zitat Price CT, Day DD, Flynn JC (1988) Behavioral sequelae of bracing versus surgery for Legg-Calve-Perthes disease. J Pediatr Orthop 8:285–287 PubMedCrossRef Price CT, Day DD, Flynn JC (1988) Behavioral sequelae of bracing versus surgery for Legg-Calve-Perthes disease. J Pediatr Orthop 8:285–287 PubMedCrossRef
22.
Zurück zum Zitat Russell RH (1987) Fracture of the femur. A clinical study. By R. Hamilton Russell, 1924. Clin Orthop Relat Res 224:4–11 PubMed Russell RH (1987) Fracture of the femur. A clinical study. By R. Hamilton Russell, 1924. Clin Orthop Relat Res 224:4–11 PubMed
23.
Zurück zum Zitat Salter RB (1980) Legg-Perthes disease: the scientific basis for the methods of treatment and their indications. Clin Orthop Relat Res 150:8–11 PubMed Salter RB (1980) Legg-Perthes disease: the scientific basis for the methods of treatment and their indications. Clin Orthop Relat Res 150:8–11 PubMed
24.
Zurück zum Zitat Saran N, Varghese R, Mulpuri K (2012) Do femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calve-Perthes disease? A meta-analysis. Clin Orthop Relat Res 470:2383–2393 PubMedCentralPubMedCrossRef Saran N, Varghese R, Mulpuri K (2012) Do femoral or salter innominate osteotomies improve femoral head sphericity in Legg-Calve-Perthes disease? A meta-analysis. Clin Orthop Relat Res 470:2383–2393 PubMedCentralPubMedCrossRef
25.
Zurück zum Zitat Savvidis E, Loer F (1992) Ein Behandlungsprinzip mit fragwürdiger Wirksamkeit bei Morbus Perthes. Z Orthop Ihre Grenzgeb 130:120–124 PubMedCrossRef Savvidis E, Loer F (1992) Ein Behandlungsprinzip mit fragwürdiger Wirksamkeit bei Morbus Perthes. Z Orthop Ihre Grenzgeb 130:120–124 PubMedCrossRef
26.
Zurück zum Zitat Segev E (2004) Treatment of severe late onset Perthes‘ disease with soft tissue release and articulated hip distraction. J Pediatr Orthop B 13:345 PubMedCrossRef Segev E (2004) Treatment of severe late onset Perthes‘ disease with soft tissue release and articulated hip distraction. J Pediatr Orthop B 13:345 PubMedCrossRef
27.
Zurück zum Zitat Serlo W, Heikkinen E, Puranen J (1987) Preoperative Russell traction in Legg-Calve-Perthes disease. J Pediatr Orthop 7:288–290 PubMedCrossRef Serlo W, Heikkinen E, Puranen J (1987) Preoperative Russell traction in Legg-Calve-Perthes disease. J Pediatr Orthop 7:288–290 PubMedCrossRef
28.
Zurück zum Zitat Shah H, Siddesh ND, Joseph B et al (2009) Effect of prophylactic trochanteric epiphyseodesis in older children with Perthes‘ disease. J Pediatr Orthop 29:889–895 PubMedCrossRef Shah H, Siddesh ND, Joseph B et al (2009) Effect of prophylactic trochanteric epiphyseodesis in older children with Perthes‘ disease. J Pediatr Orthop 29:889–895 PubMedCrossRef
29.
Zurück zum Zitat Shim SS, Day B, Leung G (1981) Circulatory and vascular changes in the hip following innominate osteotomy: an experimental study. Clin Orthop Relat Res 160:258–267 PubMed Shim SS, Day B, Leung G (1981) Circulatory and vascular changes in the hip following innominate osteotomy: an experimental study. Clin Orthop Relat Res 160:258–267 PubMed
30.
Zurück zum Zitat Sponseller PD, Desai SS, Millis MB (1988) Comparison of femoral and innominate osteotomies for the treatment of Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 70:1131–1139 Sponseller PD, Desai SS, Millis MB (1988) Comparison of femoral and innominate osteotomies for the treatment of Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 70:1131–1139
31.
32.
Zurück zum Zitat Stulberg SD, Cooperman DR, Wallensten R (1981) The natural history of Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 63:1095–1108 Stulberg SD, Cooperman DR, Wallensten R (1981) The natural history of Legg-Calve-Perthes disease. J Bone Joint Surg [Am] 63:1095–1108
33.
Zurück zum Zitat Sudesh P, Bali K, Mootha AK et al (2010) Arthrodiastasis and surgical containment in severe late-onset Perthes disease: an analysis of 14 patients. Acta Orthop Belg 76:329–334 PubMed Sudesh P, Bali K, Mootha AK et al (2010) Arthrodiastasis and surgical containment in severe late-onset Perthes disease: an analysis of 14 patients. Acta Orthop Belg 76:329–334 PubMed
34.
Zurück zum Zitat Terjesen T, Wiig O, Svenningsen S (2012) Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calve-Perthes disease. Clin Orthop Relat Res 470:2394–2401 PubMedCentralPubMedCrossRef Terjesen T, Wiig O, Svenningsen S (2012) Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calve-Perthes disease. Clin Orthop Relat Res 470:2394–2401 PubMedCentralPubMedCrossRef
35.
Zurück zum Zitat Thompson GH (2011) Salter osteotomy in Legg-Calve-Perthes disease. J Pediatr Orthop 31:S192–S197 PubMedCrossRef Thompson GH (2011) Salter osteotomy in Legg-Calve-Perthes disease. J Pediatr Orthop 31:S192–S197 PubMedCrossRef
36.
Zurück zum Zitat Thompson GH, Price CT, Roy D et al (2006) Legg-Calvé-Perthes disease. In: Birch JG (Hrsg) AAOS instructional course lectures. American Academy of Orthopaedic Surgeons, Rosemont, S 27–44 Thompson GH, Price CT, Roy D et al (2006) Legg-Calvé-Perthes disease. In: Birch JG (Hrsg) AAOS instructional course lectures. American Academy of Orthopaedic Surgeons, Rosemont, S 27–44
37.
Zurück zum Zitat Vandermeer JS, Kamiya N, Aya-ay J et al (2011) Local administration of ibandronate and bone morphogenetic protein-2 after ischemic osteonecrosis of the immature femoral head: a combined therapy that stimulates bone formation and decreases femoral head deformity. J Bone Joint Surg [Am] 93:905–913 Vandermeer JS, Kamiya N, Aya-ay J et al (2011) Local administration of ibandronate and bone morphogenetic protein-2 after ischemic osteonecrosis of the immature femoral head: a combined therapy that stimulates bone formation and decreases femoral head deformity. J Bone Joint Surg [Am] 93:905–913
38.
Zurück zum Zitat Volpon JB (2012) Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calve-Perthes disease: a prospective controlled trial. Int Orthop 36:1899–1905 PubMedCentralPubMedCrossRef Volpon JB (2012) Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calve-Perthes disease: a prospective controlled trial. Int Orthop 36:1899–1905 PubMedCentralPubMedCrossRef
39.
Zurück zum Zitat Vukasinovic Z, Spasovski D, Vucetic C et al (2009) Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease. Int Orthop 33:1377–1383 PubMedCentralPubMedCrossRef Vukasinovic Z, Spasovski D, Vucetic C et al (2009) Triple pelvic osteotomy in the treatment of Legg-Calve-Perthes disease. Int Orthop 33:1377–1383 PubMedCentralPubMedCrossRef
40.
Zurück zum Zitat Wenger DR, Pring ME, Hosalkar HS et al (2010) Advanced containment methods for Legg-Calve-Perthes disease: results of triple pelvic osteotomy. J Pediatr Orthop 30:749–757 PubMedCrossRef Wenger DR, Pring ME, Hosalkar HS et al (2010) Advanced containment methods for Legg-Calve-Perthes disease: results of triple pelvic osteotomy. J Pediatr Orthop 30:749–757 PubMedCrossRef
41.
Zurück zum Zitat Wild A, Westhoff B, Raab P et al (2003) Die nichtoperative Therapie des Morbus Perthes. Orthopade 32:139–145 PubMedCrossRef Wild A, Westhoff B, Raab P et al (2003) Die nichtoperative Therapie des Morbus Perthes. Orthopade 32:139–145 PubMedCrossRef
Metadaten
Titel
Aktuelle Behandlungsstrategie des Morbus Perthes
verfasst von
B. Westhoff
F. Martiny
Prof. Dr. R. Krauspe
Publikationsdatum
01.12.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Orthopädie / Ausgabe 12/2013
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-012-2048-y

Weitere Artikel der Ausgabe 12/2013

Der Orthopäde 12/2013 Zur Ausgabe

springermedizin.de - die Redaktion empfiehlt

springermedizin.de - die Redaktion empfiehlt

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, DICOM-Daten, Videos und Abbildungen. » Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Orthopädie und Unfallchirurgie und bleiben Sie gut informiert – ganz bequem per eMail.