Abstract
Objective
To compare the effectiveness of arthrodiastasis with shelf acetabuloplasty for Perthes' disease in older children, by assessing the radiological outcome in matched pairs of children at skeletal maturity.
Design
Retrospective observational study case series.
Patients and Methods
Children were selected who had Perthes' disease, which was in the initial or fragmentation stage at presentation, with a chronological age > 7 years at diagnosis and Grade B or B/C borderline (using the modified Herring's lateral pillar classification). Exclusion criteria were other surgery for Perthes', and if they were skeletally immature at time of latest follow up. The matching criteria were age at diagnosis, sex, ethnicity, modified lateral pillar classification. The children who had a shelf were drawn from one institution and arthrodiastasis from the other. In both centres, the prevalence of Perthes' is similar. 11 matched pairs were identified (22 children).
Main outcome measures
Stulberg class at skeletal maturity and complications Results - There was no statistical difference between the Stulberg class at maturity in the two groups. 6 pairs had the same class. One shelf patient developed a temporary peroneal nerve palsy. Nine of the eleven arthrodiastasis patients developed pin track infections and one had a pin breakage.
Conclusion
The study is limited by small numbers, but the radiographic results appear similar. The complications were different. Both appear valid options for B or B/C border hips before onset of head deformity, but ultimately the choice of treatment depends on patient and surgeon preference.
