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The long-term prognosis of unilateral Perthes' disease
Insights
This study identifies key predictors of long-term outcomes in Perthes disease. Early diagnosis and specific radiographic signs significantly influence prognosis, guiding treatment strategies for better patient results.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Radiology
Background:
- Perthes disease affects the hip joint in children, potentially leading to long-term complications.
- Identifying prognostic factors is crucial for effective management and predicting outcomes.
Purpose of the Study:
- To determine the most significant long-term prognostic factors in unilateral Perthes disease.
- To correlate various clinical and radiographic parameters with long-term hip function and morphology.
Main Methods:
- A cohort of 61 unilateral Perthes disease patients was studied.
- Long-term follow-up (average 25 years) assessed radiographic outcomes (Stulberg, Cooperman, Wallensten classes) and functional scores (Iowa hip score).
- Statistical analysis correlated age at diagnosis, age at follow-up, Catterall group, acetabular coverage, and femoral head subluxation with outcomes.
Main Results:
- Significant correlations were found between radiographic class and hip score, age at diagnosis and radiographic class, age at follow-up and hip score, and femoral head subluxation and hip score.
- Three distinct age groups at diagnosis demonstrated different long-term prognoses.
- Patients diagnosed before age five showed a correlation between Catterall group and favorable Stulberg classes (I and II).
Conclusions:
- Age at diagnosis is a critical factor in predicting long-term outcomes for Perthes disease.
- Younger patients (<5 years) diagnosed with Perthes disease and favorable Catterall classifications have better radiographic outcomes.
- Older patients (>9 years) at diagnosis generally have a poor prognosis, irrespective of the Catterall group, resulting in poorer radiographic outcomes.
Abstract:
We have attempted to identify the most important long-term prognostic factors in Perthes' disease by studying 61 patients affected unilaterally. The average age at diagnosis was 7 years 5 months and at follow-up it was 32 years, an average interval of 25 years. The age at diagnosis, age at follow-up, Catterall group, acetabular coverage, femoral head subluxation and the other head-at-risk signs were statistically correlated with Stulberg, Cooperman and Wallensten (1981) radiographic classes and the Iowa hip score. Statistically significant correlations were found between Stulberg class and Iowa hip score; age at diagnosis and Stulberg class; age at follow-up and Iowa hip score; and between lateral subluxation of the femoral head and Iowa hip score. Three age-groups of patients were found to carry different long-term prognoses. Those below five years of age at diagnosis showed a statistically significant correlation between Catterall group and Stulberg Classes I and II. Patients between five and nine years of age at diagnosis showed a significant correlation between Catterall group and Stulberg Classes I, II, III and IV while in patients diagnosed after nine years of age there was no statistical correlation between Catterall group and Stulberg class, all having a poor prognosis and ending up in Stulberg Classes III, IV and V.