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Published on: September 7, 2022
Surgical outcome for children in the early phase of Perthes' disease
Wojciech Wichłacz1, Bogolub Sotirow, Andrzej Sionek
1I Oddział Urazowo-Ortopedyczny Dzieci, Klinika Ortopedii, Otwock.
Insights
Surgical treatment of early-stage Perthes
Area of Science:
- Pediatric Orthopedics
- Pediatric Orthopedics
- Pediatric Orthopedics
Background:
- Perthes' disease affects children, impacting the femoral head.
- Early surgical intervention is crucial for managing Perthes' disease.
- This study focuses on long-term outcomes of surgical treatment in early-phase Perthes' disease.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical treatment for early-phase Perthes' disease.
- To assess the radiological progression and clinical results after osteotomy.
- To determine the effectiveness of surgical intervention in halting disease progression.
Main Methods:
- Retrospective analysis of 128 children treated with transverse inter- and sub-trochanteric osteotomy.
- Patients aged 3-13 years at surgery with a follow-up of 5-25 years.
- Radiological assessment using Stulberg and Mose classifications; Herring group analysis.
Main Results:
- 72% good, 23% satisfactory, and 5% poor outcomes reported.
- 81% of hips were classified as Herring group A or B, indicating early disease stage.
- 60% of patients did not enter or only began the fragmentation stage post-surgery.
Conclusions:
- Surgical intervention appears to halt the progression of Perthes' disease.
- Femoral osteotomy may release a factor that limits disease development.
- Surgery is effective in arresting disease at the pre-fragmentation stage.
Abstract:
Background. This article presents long-term outcomes in the surgical treatment of children in the early phase of Perthes' disease, i.e. Reinberg phases I and II. Material and methods. From among 650 children operated during the period 1976-1998, 128 patients reported for follow-up, including 102 boys and 26 girls, who had been operated by transverse inter- and sub-trochanteric osteotomy according to the authors' own concept. These children ranged in age at surgery from 3 to 13 years (average 7 years); the observation period ranged from 5 to 25 years (average 11 years). The radiological picture of the femoral head in long-term follow-up after surgery was assessed according to the Stulberg and Mose classification schemes. Results. There were 72% good outcomes, 23% satisfactory, and 5% poor. Retrospectively, 105 hips (81%) of the total 128 were classified radiologically to Herring group A or B. This large percentage of A and B results indicates that the disease process was just beginning, and had not yet involved the entire femoral head. Of all the operated patients, 77 (60%) did not go through the fragmentation period or only just entered the initial phases of stage III. Conclusions. Our observations would indicate that in the course of surgery the progress of the disease is halted, as though the femoral osteotomy released an unknown factor limiting the development of the disease and halting its progress at the phase at which the surgery is performed.