Surgical treatment for Perthes disease at risk

The treatment of Perthes disease has remained controversial ever since the disorder was first described in 1910. It is generally accepted that surgical treatment is favorable if the patients are at risk clinically or radiologically. From March 1983 to March 1988, 13 patients suffering from severe Perthes disease were treated surgically at the National Taiwan University Hospital. There were 12 boys and one girl with an average age of eight years and eight months (ranging from five years and 10 months to 12 years and one month). They were all at risk either clinically or radiologically. All patients suffered from hip pain, limping and limited range of motion, except one who was pain-free. All femoral heads were classified as Catterall group III or IV, and had at least two radiologic risk signs. After nonsurgical treatment for an average duration of 13 months, including bed rest, traction and bracing as inpatients or outpatients, operations, including varus derotational osteotomy of the femur in three, Salter innominate osteotomy in one, combined surgery in three and triple innominate osteotomy in six patients, were performed. After following up for 36 months, we determined that surgical containment for Perthes disease can achieve satisfactory results. In our preliminary report, triple innominate osteotomy was one of the relatively simple and effective procedures.