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Perthes' disease: prognosis in children under six years of age
1Service de Chirurgie Orthopédique Pédiatrique, Hôpital Lapeyronie, 391, Avenue du Doyen G. Giraud, 34295 Montpellier, France. canavese_federico@yahoo.fr
Insights
Children under six with Perthes' disease generally have good outcomes. Severe cases show similar results with conservative or operative treatment, though Catterall grade-III hips fare better than grade-IV.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasia Research
- Pediatric Hip Conditions
Background:
- Perthes' disease (Legg-Calvé-Perthes disease) affects the hip joint in children.
- Early-onset Perthes' disease (before age six) is associated with a better prognosis.
- Disease severity, classified by Catterall grading, influences treatment strategies and outcomes.
Purpose of the Study:
- To evaluate the long-term outcomes of Perthes' disease in children diagnosed before age six.
- To compare the effectiveness of conservative versus operative treatment for severe Perthes' disease (Catterall grades III and IV).
- To assess the prognostic value of Catterall grading in early-onset Perthes' disease.
Main Methods:
- Retrospective analysis of 166 pediatric hips diagnosed with Perthes' disease before age six.
- Classification of disease severity using the Catterall grading system (I-IV).
- Treatment modalities included conservative (weight-bearing restriction) and operative (innominate osteotomy) approaches.
- Radiological assessment of outcomes at skeletal maturity using Stulberg and Mose classifications.
Main Results:
- All mild Perthes' disease cases (Catterall I-II) achieved good results.
- In severe cases (Catterall III-IV), 67.3% had good outcomes, 22.4% fair, and 10.3% poor.
- No significant difference in outcomes was observed between conservative and operative treatments for severe disease (p > 0.05).
- Catterall grade-III hips demonstrated better outcomes than grade-IV hips, irrespective of treatment method.
Conclusions:
- Early-onset Perthes' disease (before age six) generally leads to favorable long-term outcomes.
- For severe Perthes' disease, surgical intervention does not significantly improve outcomes compared to conservative management.
- Catterall grading is a valuable prognostic indicator, with lower grades correlating to better results.
Abstract:
Children presenting with Perthes' disease before their sixth birthday are considered to have a good prognosis. We describe 166 hips in children in this age group. The mean age at onset of the disease was 44 months (22 to 72). Mild forms (Catterall I and II) were treated conservatively and severe forms (Catterall III and IV) either conservatively or operatively. The aim of the former treatment was to restrict weight-bearing. Operative treatment consisted of innominate osteotomy and was indicated by a Conway type-B appearance on the bone scan. All the patients were followed to skeletal maturity with a mean follow-up of 11 years (8 to 15). The end results were evaluated radiologically using the classifications of Stulberg and Mose. A total of 50 hips were Catterall grade-I or grade-II, 65 Catterall grade-III and 51 Catterall grade-IV. All hips with mild disease had a good result at skeletal maturity. Of the hips with severe disease 78 (67.3%) had good (Stulberg I and II), 26 (22.4%) fair (Stulberg III) and 12 (10.3%) poor results (Stulberg IV and V). Of the Catterall grade-III hips 38 were treated conservatively of which 31 (81.6%) had a good result, six (15.8%) a fair and one (2.6%) a poor result. Operative treatment was carried out on 27 Catterall grade-III hips, of which 21 (77.8%) had a good, four (14.8%) a fair and two (7.4%) a poor result. By comparison conservative treatment of 19 Catterall grade-IV hips led to ten (52.7%) good, seven (36.8%) fair and two (10.5%) poor results. Operative treatment was carried out on 32 Catterall grade-IV hips, of which 16 (50.0%) had a good, nine (28.1%) a fair and seven (21.9%) a poor result. We confirm that the prognosis in Perthes' disease is generally good when the age at onset is less than six years. In severe disease there is no significant difference in outcome after conservative or operative treatment (p > 0.05). Catterall grade-III hips had a better outcome according to the Stulberg and Mose criteria than Catterall grade-IV hips, regardless of the method of treatment.
