Posted by Gary on July 30, 2003 at 17:43:20:
In Reply to: Treatment with Atlanta Brace posted by Leandro Cardoso on July 29, 2003 at 13:21:08:
Leandro, I do not think that the Atlanta Brace does not produce very good results. I think that recent studies have concluded that bracing, in general, is no more effective and produces no better results than surgical treatments. If that conclusion is correct, then many would believe that surgical treatment is the better choice because it has a relatively short recovery period and within weeks, the child can return to normal activities.
It appears that bracing offers reasonably good results if the brace is applied to a hip with a normal full range of motion (ROM) and if the brace can contain the femoral head within the acetabulum. Of course, the child must wear the brace as prescribed.
The negative aspects of bracing are the appearance of the brace, the generally longer treatment time and the possibility of either poor compliance with brace wear or the loss of containment because of loss of ROM.
The negative aspects of surgical treatment include intra- and postoperative complications/infection, possible leg length discrepancies, overgrowth of the greater trochanter, the need for subsequent removal of internal fixation and the possibility that satisfactory containment may not be achieved or maintained.
It is not an easy choice. Each physician must use his/her best judgement in recommending a course of treatment. Each parent should question the recommendation carefully and fully understand why that course of treatment is being recommended. A second opinion is advisable to allow for differing expertise on the part of physicians.
I am under the impression that a 4 year old child is likely to have a good outcome without significant intervention. Limitation of activity and maintenance of range of motion should be effective in all but cases with full head involvement. If you have access to the writings of either Dror Paley or J. A. Herring, they both seem to have significant expertise in the diagnosis and treatment of Perthes.