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Outcome of late-onset Perthes' disease using four different treatment modalities
M K Osman1, D J Martin, D A Sherlock
1Royal Hospital for Sick Children, Glasgow, G3 8SJ, Scotland, UK, drar_2000@yahoo.com.
Insights
For children with Perthes' disease over age 8, outcomes are generally poor regardless of treatment. Acetabular augmentation showed promise in improving hip joint metrics and preventing deformity compared to other methods.
Area of Science:
- Pediatric Orthopedics
- Pediatric Rheumatology
- Pediatric Traumatology
Background:
- Perthes' disease in children over 8 years old typically has a poor prognosis.
- The effectiveness of various treatment modalities in altering the natural history of Perthes' disease in this age group remains unclear.
Purpose of the Study:
- To compare the outcomes of four different treatment modalities for Perthes' disease in children aged 8 years and older.
- To investigate if any treatment can positively influence the disease's progression in this specific patient cohort.
Main Methods:
- Retrospective review of prospectively collected data from 44 children (48 hips) diagnosed with Catterall grade 2, 3, or 4 Perthes' disease with onset at age 8 or older.
- Patients were categorized into four groups: no treatment, and three interventional groups. Untreated patients were older with poorer baseline indices.
Main Results:
- Only 19% of all patients achieved a satisfactory Stulberg grade II outcome across all treatment modalities.
- Increasing age, greater initial femoral head deformity, and more extensive head involvement correlated with poorer outcomes.
- Acetabular augmentation demonstrated superior results in improving the C/B ratio and center-edge angle, and prevented progressive femoral head deformity.
Conclusions:
- Treatment outcomes for Perthes' disease in older children are generally poorer and worsen with increasing age.
- While no treatment guarantees a favorable outcome for significant initial deformity, acetabular augmentation offers advantages over no treatment, varus osteotomy, and plaster treatment.
Purpose:
The outcome of Perthes' disease in children over 8 years tends to be poor. It is unclear whether any treatment modality alters the natural history. This study compares the results of four treatment modalities for this group of patients.
Methods:
A retrospective review was performed of prospectively collected data for 44 children (48 hips) with Catterall grade 2, 3 or 4 Perthes' disease with onset age 8 years or older followed to maturity. Patients were divided into four groups (a no-treatment group and three interventional groups). The interventional groups were demographically similar but the untreated patients were older and had poorer indices for most modalities.
Results:
Overall for all treatment modalities only 19% had a satisfactory Stulberg grade II outcome. Poorer outcomes (as assessed by center-edge angle and percentage femoral head coverage) were associated with increasing age, greater initial head deformity, and more head involvement. Initial head deformity did not remodel for any group and progressed despite plaster treatment or varus osteotomy but not after acetabular augmentation. Acetabular augmentation gave better outcomes for C/B ratio and center-edge angle.
Conclusions:
Whatever the treatment, the outcome is poorer with increasing age. No treatment guarantees a good result for significant head involvement or initial deformity but acetabular augmentation improves C/B ratio and center-edge angle and prevents progressive femoral head deformity compared with no treatment, varus osteotomy, and plaster treatment.
