Ambulatory containment treatment in Perthes' disease

The results of four different ambulatory methods used in the treatment of 248 patients with Perthes' disease were compared in five different hospitals. In each hospital the patient population was selected for the era of treatment policy. Seventy-two patients were treated with crutches alone, 58 with a Scottish Rite orthosis, 48 with a Newington abduction orthosis (a bilateral long-leg brace holding the hips in abduction and internal rotation), and 70 with proximal femoral osteotomy. The end results of treatment were rated according to head sphericity using the MOSE method. Prognostic indicators were recorded, including age of onset of disease, Catterall type, and femoral subluxation. Patients with partial-head involvement under eight years of age at disease onset with minimal lateral subluxation (less than 1.5 lateral subluxation ratios) and no proximal subluxation fared equally well with crutch walking or any of the three ambulatory-containment treatments studied. With greater degrees of subluxation, all three containment groups were superior to crutch walking and all were equally effective. In partial-head involvement, patients between eight and 12 years of age, with or without lateral or proximal subluxation, all three ambulatory containment methods were superior to crutch walking. Femoral osteotomy and the Newington abduction orthosis were equally effective. Only five Scottish Rite patients were in this age group, too small a number to compare with the other treatment methods. Patients with partial-head involvement over 12 years of age at disease onset had poor results. For patients with total-head involvement under eight years of age at disease onset, femoral osteotomy was correlated with a lesser degree of femoral head flattening than either brace or crutch treatment. In whole-head involvement patients over eight years old at disease onset, all three ambulatory containment methods were equally effective and superior to crutch walking; however, there were few crutch walking and Newington abduction arthrosis patients in this age group.