Late results of treatment in Perthes' disease by a functional method

Two hundred ninety-six cases of Perthes' disease with 334 affected hips (38 children had bilateral involvement) were treated by the principle of containment in a "broomstick cast" in abduction and internal rotation, preserved motion in the hip, and continuous traction. Prognostic indicators were recorded, including the age at the onset of the disease, Catterall Group, and risk factors. The mean follow-up period was 8.6 years. The average age at the last examination was 14.1 years (range, six to 25 years). The end results of the treatment were evaluated roentgenographically by the Heyman and Herndon method of quotients. In these 334 treated hips, the results were very good in 216 cases and good in 92 cases (92% very good and good combined), whereas in 23 cases, results were fair and in three, poor (8% fair and poor combined). The results were dependent on the age at the time of diagnosis, the degree of femoral head involvement, and presence of "head at risk," particularly femoral subluxation. The fair and poor results were found in children older than nine years of age, with total head involvement, crushing epiphysis, and presence of risk factors. The results in this study suggest the superiority of treatment in Perthes' disease by a functional method in comparison with the results of treatment by orthosis or femoral osteotomy. This method shortened considerably the time of treatment; the average time was 13 months.