Perthes' disease: a comparison between two methods of treatment, Thomas' splint and femoral osteotomy

The results of twenty-four hips treated by femoral derotation varus osteotomy and sixty-six hips treated by Thomas' splint are compared. The average follow-up period was eight years with in a range of two to twenty years. All diagnoses were classified into Catterall's four groups according to the degree of epiphyseal alterations. Other factors affecting the outcome, such as subluxation of the femoral head, age at onset and stage at treatment were studied. Osteotomy improved the results remarkably in Group 3 and Group 4 hips. Femoral osteotomy would be indicated for those cases which show extended epiphyseal necrosis and subluxation of the femoral head. Even osteotomy has limitations in obtaining good results in older children with extended necrosis and in an advanced stage in which the femoral head is already deformed and regenerated.