Arthrodiastasis in the Management of Perthes’ Disease: A Systematic Review

• Published in: QJM : An International Journal of Medicine 2020-03, Vol.113 (Supplement_1)
• Main Authors: Fahmy, H, Alkersh, M, Ibrahim, Y H
• Format: Article
• Language: English
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcaa059.011

Abstract Background This systematic review explores the relevant literature to assess the efficacy of the use of arthrodiastasis in the management of Perthes disease. Until this moment, arthrodiastasis is not well established for its use in Perthes disease as opposed to other containment procedures. Furthermore, there are no clear indications for its use in this disease. Methodology 12 articles were matched to the inclusion criteria and all articles were reviewed and radiological and clinical data was collected and compiled. Results a significant increase in postoperative range of motion compared to the preoperative ones was found. Final Stullberg classification was ascertained showing majority of patients ending with stages two and three. Complications were also assessed with majority of them being superficial pin tract infections. Conclusion the use of arthrodiastasis is a valid treatment option for Perthes disease however more articles need to be produced showing comparative data of arthrodiastasis versus other containment procedures. Index Terms- Arthrodiastasis, Perthes’ Disease, LCPD, Hinged Distraction the preservation of an intact and congruent femoral head. It is proposed that by applying distraction early in the disease, before any significant collapse of the femoral head had occurred, further fragmentation would be halted.[3]Articulated hip distraction maintains the proper head position by containment in abduction, extension, and neutral rotation. It also decreases joint pressure and thus decreases the deforming force and provides a good environment for cartilage repair. The femoral head deformity that develops in Perthes’ disease is believed to occur during this fragmentation phase of the disease. The possibility for joint motion allows for articular cartilage nutrition and the molding effect of the acetabulum. The aim of the articulated distraction method is to neutralize muscle and weight-bearing forces, to prevent stress fractures of subchondral immature bone, and to encourage synovial circulation and promote creeping substitution by breaking the ‘vicious circle’ of necrosis.[4]