Therapy for Perthes disease

introduction

When a child at Perthes disease If you fall ill, you must primarily try to relieve the affected leg and deform the Femoral head to prevent. Will these therapeutic measures be successful during the Breakdown and rebuilding of the bone If carried out during the course of the disease, the prognosis is good. The child can cure without permanent damage.
The disease process itself can go through no currently known therapy be influenced and usually lasts 4 years. Since complete relief of the hip joint is sometimes not possible or is initiated too late, deformities still occur again and again. These usually have to be straightened surgically, otherwise movement restrictions and pain can occur. The healing process is usually positively influenced by an operation. Often times it is used for support physiotherapy used. This maintains and trains mobility - a prerequisite for any therapy.

surgery

Indication for surgery

If the joint head and the joint socket are optimally adapted to one another, this is called "containment“(English: containment). The hip roof encompasses the femoral head as completely as possible. If it doesn't, it can too Restrictions on movement come. If an operation is a question, attention is paid to the “containment” status of the joint on the one hand, and to the Catterall group on the other. This group classification includes four different stages, which, however, do not correspond to the general disease stages. They describe in ascending order from stage 1 to 4, how bad the defect of the femoral head is pronounced during Perthes disease. An incomplete containment and Catterall groups 3 and 4 can be an indication for surgery. Usually the following principle applies: very young or young patients with a low Catterall group should initially conservative be treated. The doctors treating you must carefully consider the indication for surgery. If mobility deteriorates during conservative therapy, surgical measures can be weighed up again.

Varus osteotomy

In the Varus osteotomy the patient is on Thigh bone operated on. A wedge is cut out of the bone with the pointed end facing the outside of the leg. As a result, the femoral head tilts towards the center of the body (or body plumb). A slope of 10 to 15 degrees is aimed for. This change in position means that the joint head lies better in the joint socket again. In addition to the actual treatment effect, a varization osteotomy has something else to offer: it sometimes shows that the destroyed femoral head regenerates faster after the operation. It is believed that the surgical changes were made to the bone Increase healing stimulus and thus promote the growth of bone substance.

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert

Operation according to Salter

Has the Varus osteotomy If the desired result is not achieved or if such an operation is decided against, a pelvic surgery can be the result Operation according to Salter be performed.
The principle is similar here, but the other way around - a wedge is used instead of removing bone material. The Iliac bone of the pelvic girdle is sawn off horizontally in the area of ​​the joint socket and a wedge is inserted between the bone fragments. The hip roof is now more inclined downwards, so overall flatter. As a result, the femoral head is more central in the joint. In addition, the leg length shortening, which was caused either by the varization osteotomy or by the Perthes disease occurred, balanced.
After the operation, intensive pain therapy and immobilization with the help of Plaster casts and bed rest guaranteed. Salter's operation is associated with more complications than varization osteotomy. These include, for example, disturbances in wound healing and damage to nerves or vessels.

Physiotherapy after the operation

Physiotherapy should not be performed immediately after the operation. The bone must first be spared and heal before the joint can be loaded again. After about 6 weeks, the use of physiotherapeutic treatment can be considered.

Physiotherapy without surgery

In almost all stages of Perthes disease you can conservative forms of treatment can be applied - for example physiotherapy. In this clinical picture, the movement of the leg away from the body is particularly important (Abduction) and the internal rotation in the hip joint is restricted. In addition to training that focuses on these movements, a Training the gluteal muscles (Gluteal muscles) bring about improved joint stabilization. Physiotherapy should maintain mobility in the joint without creating additional stress.

Exercises

Mainly show up in Perthes disease Restrictions on movement during the Internal rotation and at the Abduction. Abduction is the spreading of the leg - the movement of the leg from the body perpendicular to the outside. Exercises that train this axis of movement can be performed both while standing and sitting.
When standing, the leg can be moved back and forth between two fixed points. One point is just behind the opposite foot, so the legs cross each other as you move. The other point is on the side of the leg to be trained, about so far away that the leg is spread 45 degrees. If you want to train abduction while sitting, the easiest way to do this is with a rubber band (terra band). With the legs bent, the band is placed around the knees.These must now be pressed outwards against the resistance.

Internal rotation in the hip joint can also be practiced while standing or sitting. The patient places the heel on the floor and swings the forefoot inwards and outwards in order to train the rotational movements while standing. The elastic band (Terra band) is also used when sitting. It is attached to a fixed point and a loop is placed around the foot. While the leg is straight, the foot is turned inward. To strengthen the gluteal muscles, simple stretching movements in the hips, such as when climbing stairs, are sufficient.

Relief of the hip

In addition to surgical relief of the hip, a Load reduction be brought about. The simplest means is that bed restwhich, however, can lead to social isolation for the children concerned. Storage in a stroller if the child is not yet too old or mobilization with the help of one Wheelchair are more acceptable options. Other walking aids can also be used.

Duration of therapy

The duration of therapy for existing Perthes disease can vary from patient to patient. As a rule, the complete reconstruction of the femoral head takes several but at least 2 years. The Restoration of the bone substance so far cannot be accelerated by any known treatment measure. Just one Surgery on the femur can possibly promote bone growth and accelerate healing. The duration of exposure plays an enormous role in therapy. Surgery is more risky than conservative therapy, but immobilization and reduce psychological stress on the child. An accompanying physiotherapy treatment can be necessary beyond the normal therapy framework and last years after the actual illness.