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A comparative analysis of conservative and surgical treatment of Perthes' disease
Wiesław Nowacki1, Edward Szymkowiak, Jacek Futyma
1Katedra i Klinika Ortopedii A. M., Bydgoszcz.
Insights
Surgical treatment for Perthes' disease resulted in better outcomes than conservative methods, improving hip joint alignment and femoral head sphericity. Femoral osteotomy is recommended when the disease is diagnosed at the optimal developmental stage.
Area of Science:
- Pediatric Orthopedics
- Pediatric Musculoskeletal Disorders
Background:
- Perthes' disease treatment selection remains a challenge in orthopedic practice.
- Evaluating outcomes of conservative versus surgical interventions is crucial.
Purpose of the Study:
- To compare the effectiveness of conservative and surgical treatments for Perthes' disease.
- To assess radiological outcomes in children undergoing different treatment modalities.
Main Methods:
- A study involving 72 children diagnosed with Perthes' disease.
- Comparison of outcomes between 29 surgically treated patients and those treated conservatively.
- Radiological assessment using Wiberg angle, Mose sphericity, antetorsion, and cervical-metaphyseal angles.
Main Results:
- Surgical treatment led to a significantly greater Wiberg angle and less femoral head sphericity deviation.
- Conservative treatment showed less improvement in sphericity compared to surgical methods.
- Significant improvements in antetorsion and cervical-metaphyseal angles were observed post-surgery.
Conclusions:
- Surgical intervention, particularly femoral osteotomy, yields superior outcomes for Perthes' disease.
- Optimal timing of surgical intervention is key for successful treatment.
- Surgical treatment demonstrates a higher rate of favorable results compared to conservative approaches.
Abstract:
Background. The choice of treatment method for Perthes' disease is still a frequently encountered dilemma in orthopedic practice. The aim of our research was to compare outcomes after conservative and surgical treatment in patients with Perthes' disease. Material and methods. 72 children with Perthes' disease were included in the study group, of whom 29 were treated surgically. The outcome was evaluated by means of radiological parameters: the Wiberg angle, the femoral head sphericity according to Mose, the femoral antetorsion angle, and the cervical-metaphyseal angle. Results. The Wiberg angle at follow-up was significantly greater after surgical treatment, while the deviation from sphericity of the femur in the affected joint was significantly less. Sphericity of the femoral head was also significantly less in patients treated conservatively, but not as much so. The antetorsion angle was significantly smaller after surgery than before, but did not differ significantly in patients treated conservatively. The cervial-metaphyseal angle in the affected limb at check-up was signficantly less in patients treated surgically, but not in those treated conservatively. Conclusions. Surgical treatment gave considerably more "good" outcomes than did conservative methods. Femoral osteotomy is a good method of treatment for Perthes's disease, if performed at the right stage in the development of the disease.