Norwegian Perthes study

Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up.

Wiig O, Terjesen T, Svenningsen S. The Journal of bone and joint surgery. British volume 2008 · PMID 18827249 · doi:10.1302/0301-620x.90b10.20649

Question

What predicts outcome in Perthes disease and does treatment modality alter it?

Design

Prospective nationwide Norwegian cohort study with 5-year follow-up comparing treatments by hospital.

Patients

Children with unilateral Perthes disease across Norway.

Intervention

Proximal femoral varus osteotomy

Comparison

Physiotherapy or abduction orthosis

Primary outcome

Femoral head shape (Stulberg) at 5 years

Key result

Femoral head involvement and age at diagnosis were the strongest prognostic factors; in children over 6 years with more than half of the head involved, osteotomy gave significantly better femoral head sphericity than non-operative treatment.

Limitations

Non-randomised allocation by hospital; 5-year follow-up is too short to assess arthritis.

Impact on practice

Reinforces selective containment osteotomy for older children with extensive head involvement and observation for younger children.