PERTHES DISEASE. A COMPARISON BETWEEN CONSERVATIVE AND SURGICAL TREATMENT AFTER AN AVERAGE F.U. PERIOD OF 25 YEARS.

Abstract

We will report the clinical and radiographical results of a comparison between conservative and surgical treatment of Perthes disease after an average period of 25 years. All the children were observed at Orthopaedic and Traumatologic Center (CTO) of Florence between 1962 and 1989.

Patients and Methods: Nineteen patients (20 hips) treated surgically using femoral and/or pelvic osteotomies and twenty patients (21 hips) treated conservatively with pelvi-podalic casts and no weight bearig were clinically (Harris Hip Score) and radiographically (Mose, Sharp, Stulberg criteria) evaluated after an average period of 25 years (16 to 43 years), by usig an A-P hip and pelvic view and a frog-leg view of both hips. All the children were radiographically evaluated using Catterall’s and Herring’s criteria. In the “surgical group” there were 10% of cases in the I, 30% in the II, 25% in the III and 35% in the IV group of Catterall classification. In the “conservative group” these percentages were 28%, 19%, 34% and 19% respectively.

Results: In the surgical group 13 patients had an eccellent clinical result (100 to 90 points), 4 good (89 to 80), 1 fair (79 to 70) and 2 poor (< 70 points), with an average Harris Hip Score of 89,8 (57 to 100). In the conservative group there were 16 eccellent, 2 good, and 3 poor results, with an average Harris Hip Score of 98,5 (55 to 100). Using Stulberg’s criteria we had good results (I and II class) in 86% of the cases in the “conservative group” and 70% in the “surgical group”.

Discussion: We correlated clinical and radiographical signs to find out if any of these sign can be predictive and we found that the most important factor was the age of symptom’s beginning. When symptoms started before 5 years old, 95% of the hips were in I and II class of Stulberg. After 5 years this percentage was only 64%. However we will report even the other clinical-radiographical correlations.