Prognosis after conservative and operative treatment in Perthes' disease

The prognosis of Perthes' disease was studied after femoral intertrochanteric varus osteotomy in 112 patients (126 hips) and after conservative noncontainment treatment (Thomas splint) in 96 patients (106 hips). The radiographic results at or near skeletal maturity after containment treatment were good in 45%, fair in 21%, and poor in 34% of the hips. The figures after noncontainment treatment were 21%, 18% and 61%, respectively. The results support the idea that containment of the femoral head in the acetabulum should form the basis of treatment for Perthes' disease. It was very difficult to delineate signs for good prognosis; age at onset of the disease and a good containment three months postoperatively in the operatively treated group were the only signs with prognostic significance. In both groups, one fifth of the patients had an extremely poor outcome. Treatment other than varus osteotomy or noncontainment treatment should be considered in these patients.