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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2006 December;57(6):497-502
Is there evidence that conservative Legg-Calvé-Perthes disease interventions are effective?
Sinigaglia R., Gigante C., Turra S.
Clinica Ortopedica Università degli Studi di Padova, Padova
Aim. The treatment of Legg-Calvé-Perthes disease (LCPD) is controversial and not well defined. We wrote this review of the literature to understand the quality of the evidence available to support the effectiveness of the LCPD conservative treatment and whether conservative treatment really modifies the LCPD natural history.
Methods. Our critical review was carried out thanks to the PubMed Database and to the evidence based practice (EBP). The EBP is the integration of the best research evidences with clinical expertise and patient values. There are 5 different levels of evidence: 1) randomized controlled trials; 2) prospective cohort study; 3) case control or retrospective cohort study; 4) case series; 5) expert opinion or individual case report.
Results. Until August 20th 2005 there were 144 articles of clinical relevance about conservative treatment of LCPD: 16.7% of EBP level 5; 50.7% of level 4; 31.9% of level 3; none of level 2; and 0.7% of level 1.
Conclusions. The quality of evidence that supports conservative treatment for children with LCPD is not of the highest quality. There is no scientific evidence that conservative treatment modify LCPD natural history. Containment, no containment and simple symptomatic treatment have comparable effectiveness. Prolonged weight-relief and/or containment treatments are also related to social and psychological problems.