APLICACIÓN DE TRATAMIENTO HIPERBÁRICO EN EL MANEJO DEL LEGG-CALVÉ- PERTHES

The pathology of Legg-Calvé-Perthes is defined as a condition of the hip that can affect the growth plate, avascular neurosis of the ossification center of the femoral head or group of alterations of the vascularization in the ossification nuclei. Its origin is idiopathic and it occurs in the growing femur. Hyperbaric oxygenation could be useful for this pathology.

Signs and symptoms

Pain in the hip or groin thigh or knee is progressive, sometimes the pain appears abruptly and other times there is no pain.

Treatment

The basic principles of the treatment of Legg-Calvé-Perthes disease are the following: elimination of hip irritability, recovery, and maintenance of a satisfactory function, prevention of subluxation of the femoral head, maintenance of the normal sphericity of the femoral epiphysis in healing.

The short-term treatment aims to eliminate pain and stiffness and improves claudication. NSAIDs are used to relieve pain. Rest improves synovitis and prevents load on the affected joint. Continuous traction decreases muscle contraction and decreases pain by decreasing overpressure. On the containment or restraint of the femoral head, the objective is to prevent the ejection of the femoral head from the acetabulum.

In the long term, joint congruence is sought. The end of surgical attitudes is the containment of the femoral head, a decrease in continuous muscle tension, get acetabular coverage. The classic treatment that is applied consists in avoiding the action of weight by means of different procedures, with the objective that the femoral head does not deform before the reosification occurs. If it fails, it can be surgical or leave sequels.

Legg-Calvé-Perthes can be treated with hyperbaric oxygenation. According to new evidence, this pathology is ischemic damage that consequently leads to loss of osteocytes based on the knowledge that oxygen is necessary for bone vitality, healing, and remodeling.

The Harrison and Burwell studies concluded that the disease is caused by an oriented mechanical force that injures the blood vessels of the femoral head because of a constitutional defect that affects the growing bone. It was elaborated the hypothesis that early treatment with hyperbaric oxygenation can interrupt the progression of the disease.

We have sought a therapy that shortens the time of natural evolution of the disease and thus avoid surgeries and sequelae, therefore, hyperbaric oxygenation is considered as a possible treatment method. The researchers based their opinion on the fact that the most important cause of the disease is the interruption of the vascularization of the upper part of the femur and the effects related to an increase in oxygen tension in the bone, which favors the neoformation, have been demonstrated. It modulates osteoblast-osteoclastic activity, improves cellular metabolism and influences microcirculation by acting as antiedema or platelet antiaggregant.

It would accelerate the bone repair process, as well as the natural evolution time of the disease. This has been seen in the experience obtained in the aseptic necrosis of the adult.

In a multicenter study conducted by Morales Cudello and cols, 210 patients were studied from an imaging and grammatical point of view, with an average age of 6 years. Thirty-five sessions of hyperbaric oxygenation were administered divided into 3 cycles, 15, 10 and 10 separated from each other for 7 weeks.

Results obtained

In 92% of the patients, the healing time was less than 24 months, in 5% between 24 and 36 months and it did not cure 3% after 36 months of evolution and use of the complementary cycle. It is noted that 87% of patients classified as Caltterall III-IV cured in less than 24 months and those classified Caltterall I-II all cured. Only one did after this period.

There were no complications or residues. 97% of the treated ones were cured. It shortened the time of natural evolution of the disease, allowed early rehabilitation without sequelae and avoided surgery. They concluded that treatment hyperbaric oxygen therapy should be started early in cases diagnosed to interrupt the progression of the disease.

Reference

Arteaga, L; Arias, X. APPLICATION OF HYPERBARIC MEDICINE; IN THE MANAGEMENT OF THE LEGG-CALVÉ- PERTHES (Bibliographic Review). MEDICAL JOURNAL OF COSTA RICA AND CENTRAL AMERICA; Vol. LXV (585) 271-275; 2008.

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