Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome.
Herring JA, Kim HT, Browne R. The Journal of bone and joint surgery. American volume 2004 · PMID 15466720
- Question
- Does surgical containment improve radiological outcome in Perthes disease compared with non-operative treatment, and for which children?
- Design
- Prospective multicentre North American study in which each investigator used one treatment method for all of their patients.
- Patients
- Children aged 6 to 12 years at onset of untreated Legg-Calve-Perthes disease.
- Intervention
- Surgical containment (femoral varus osteotomy or innominate osteotomy)
- Comparison
- No treatment, range-of-motion exercises, or bracing
- Primary outcome
- Stulberg classification at skeletal maturity
- Key result
- Children over 8 years at onset with lateral pillar B or B/C border hips had significantly better outcomes with surgery, whereas younger children with these groups did well regardless of treatment, and lateral pillar C hips did poorly whatever the treatment.
- Limitations
- Treatment was allocated by centre rather than randomised, introducing possible confounding.
- Impact on practice
- Established age at onset and lateral pillar classification as the key prognostic factors guiding selection of older children for containment surgery.