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Radiologic Outcomes of Bilateral and Unilateral Perthes Disease: A Comparative Cohort Study
Kumar A Singh1, Vasudeva Guddattu2, Hitesh Shah1
1Department of Pediatric Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education.
Insights
Children with bilateral Perthes disease are diagnosed younger and have a longer disease duration, but their hip outcomes are similar to those with unilateral Perthes disease.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Radiology
Background:
- Perthes disease affects hip joint development in children.
- Bilateral Perthes disease presents unique challenges compared to unilateral cases.
- Understanding radiologic outcomes is crucial for treatment planning.
Purpose of the Study:
- Compare radiologic outcomes of bilateral versus unilateral Perthes disease.
- Evaluate outcomes of synchronous versus metachronous bilateral Perthes disease.
- Assess the impact of early surgical intervention on disease progression.
Main Methods:
- Retrospective analysis of 353 children with Perthes disease over 10 years.
- Comparison of 37 bilateral cases (11 synchronous, 26 metachronous) with 148 matched unilateral cases.
- Radiologic assessment using Sphericity Deviation Score (SDS) post-treatment.
Main Results:
- Bilateral Perthes disease diagnosed at a younger age (6.2 vs. 7.03 years) with longer duration.
- Comparable Sphericity Deviation Scores (SDS) between unilateral and bilateral disease groups.
- SDS outcomes for synchronous and metachronous bilateral cases were similar.
- Early surgery showed similar positive effects in bilateral and unilateral cases.
Conclusions:
- Age at onset and disease duration differ between unilateral and bilateral Perthes disease.
- Radiologic outcomes, assessed by SDS, are similar regardless of disease laterality.
- Disease onset age is the primary factor influencing SDS in bilateral Perthes disease.
Introduction:
This study was undertaken to compare the radiologic outcomes of bilateral and unilateral Perthes disease and also to evaluate the outcome of synchronous and metachronous bilateral Perthes disease.
Methods:
Of 353 children with Perthes disease followed up from presentation to healing during the last 10 years, 37 had bilateral involvement (11 synchronous and 26 metachronous onset). The radiologic outcomes of each hip of children with bilateral disease were compared with outcomes of 148 children with unilateral disease who were matched for age, sex, and treatment. Children with unilateral or bilateral diseases were treated with a proximal femoral varus derotation osteotomy if they fulfilled the criteria for surgery. The primary outcome measure was the shape of the femoral head at healing assessed by the Sphericity Deviation Score (SDS).
Results:
The children with bilateral disease were younger than those with unilateral disease (6.2 vs. 7.03 y; P<0.001), and they had a longer duration of the disease. All other characteristics of bilateral and unilateral cases were similar. The SDS values of unilateral and bilateral disease were comparable, as were the SDS of synchronous and metachronous bilateral disease. The effect of early surgery on the evolution of the disease in bilateral cases was similar to that reported in unilateral disease. The age of onset of the disease alone influenced the SDS in bilateral cases.
Conclusion:
The age at onset of the bilateral disease is lower, the duration of the disease longer than that of unilateral disease, but the disease outcome is similar.
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