[The prognostic factors in perthes disease]
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Published on: September 7, 2022
Andrzej Grzegorzewski1, Wiesław Szymczak, Marek Synder
1Katedra i Klinika Ortopedii i Ortopedii Dzieciqcej, Uniwersytet Medyczny w Lodzi.
Insights
Key risk factors for poor outcomes in Perthes disease include later onset age and specific radiological signs. Some factors like hip abduction and femoral head alignment can be modified during treatment to improve results.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Clinical Outcomes Research
Context:
- Perthes disease affects hip development in children.
- Long-term outcomes are variable and influenced by multiple factors.
- Containment methods are standard treatment approaches.
Purpose:
- To identify clinical and radiological factors predicting late outcomes in Perthes disease.
- To determine if any identified risk factors can be modified during treatment.
- To stratify risk for both unilateral and bilateral Perthes disease.
Summary:
- This study analyzed 361 hips in 311 patients with Perthes disease treated with containment methods.
- Unilateral Perthes disease risk factors for poor outcomes include age ≥9 years, Catterall group 3-4, Herring C, acetabulum type III, limited abduction (<10°), premature growth arrest, ATD index <0.8, subluxation >20%, sphericity disturbance >5mm, Gage sign, and lateral calcification.
- Bilateral Perthes disease risk factors include age >6 years, Catterall group 3-4, Herring C, limited abduction (<10°), and lateral calcification.
- Factors like femoral head subluxation, acetabulum shape, and hip abduction can be addressed during the fragmentation stage to potentially improve outcomes.
Impact:
- Identifies specific predictors of long-term outcomes in Perthes disease.
- Provides clinicians with tools to assess prognosis during the fragmentation stage.
- Highlights modifiable factors that may allow for improved treatment strategies and patient outcomes.
Abstract:
The purpose of this study was to evaluate the role of selected factors which may play role in the estimation of late result during Perthes disease and which one can be eliminated during treatment period. The study population consisted of 311 patients (50 patients with bilateral disease, 361 hips joint) who had reached skeletal maturity at last follow up. All hips were treated by containment methods (bed rest and traction in abduction, Petri cast, brace, varus osteotomy, Salter osteotomy and shelf acetabuloplasty). Both clinical and radiological parameters (taken during fragmentation stage) were included in our study: gender, age at the onset, hip joint abduction, type of treatment, extend of the femoral head necrosis according to the Herring and Catterall classification, LLD, premature growth plate arrest, ATD and ATD index, lateral acetabulum shape - type I - normal, concave lateral acetabulum margin, type II--flat, horizontal and type III--convex, sloping, femoral head subluxation, femoral head sphericity disturbance according to the Mose, risk factors according to the Catterall, Wiberg angle, Eyre-Brook index. Long-term results were evaluated according to the Stulberg classification and were divided into two groups: good result--Stulberg group 1 or 2 and poor and bad result--Stulberg group 3, 4 or 5. The unilateral and bilateral Perthes disease was estimated separately. The statistical analysis revealed in unilateral Perthes disease that next risk factors may lead to poor or bad late result: age at the onset 9 and more years, group 3 or 4 according to Catterall and group C according to Herring classification, type III lateral acetabulum shape, hip joint abduction less than 10 degrees, premature growth plate arrest, ATD index less than 0.8, femoral head subluxation more than 20%, femoral head sphericity disturbance more than 5mm, Gage sign, calcification laterally to the femoral head (sensitivity 85.0%, specificity 98.7%). Bilateral Perthes disease: age at the onset over 6 years, group 3 or 4 according to Catterall and group C according to Herring classification, hip joint abduction less than 10 degrees and calcification laterally to the femoral head (sensitivity 81.8%, specificity 92.3%). The statistical analysis showed which clinical and radiological factors may play an important role in estimation of late results during Perthes disease. Additionally during fragmentation stage of Perthes disease we have possibility to correct or eliminate some of the risk factors - femoral head subluxation, lateral acetabulum shape and hip joint abduction and improve the late result.
