Legg-Calvé-Perthes disease. Long-term evaluation of non-containment treatment

Eighty hips with unilateral Legg-Calvé-Perthes disease were evaluated at an average follow-up of 22.4 years to determine the long-term results of treatment by a weight-relieving sling or harness. Results were good in sixty-four patients, fair in nine, and poor in seven. The patients with fair results had no clinical symptoms despite unacceptable roentgenograms. The hips that were most likely to have unsatisfactory results were those with Catterall Group-III or IV involvement and with onset at the age of six years or later, but of fifty-eight patients with Catterall Group-III or IV grades (eighteen of whom were six years old or older), forty-two had good results. Catterall's classification could not be accurately applied for an average of 8.1 months after the onset of disease. Identification of so-called head-at-risk signs, while it was important, appeared to add little to the Catterall grading as a prognostic index or therapeutic guide. Thirty-nine hips were identified as being at risk, including six of the seven with poor results and all of the nine hips with fair results.