Prognosis in Perthes' disease: A comparison of radiological predictors

Abstract

We compared the prognostic value of the Catterall grouping, the Salter-Thompson grading, the arthrographic shape of the femoral head, and the Herring lateral pillar grouping during the fragmentation stage of Perthes' disease in 73 patients with 81 affected hips. Radiographs were available for study from the onset of the disease until skeletal maturity. We used the Stulberg classification to assess outcome. The Herring grade and arthrographic sphericity proved to be the best predictors of final outcome. Combining these two values further increased the predictive value. All but one patient in Herring group A achieved an excellent outcome. In Herring group B, the age of the child and the sphericity of the femoral head influenced the end result. If the child was less than seven years old at the onset of symptoms the prognosis was invariably good and all spherical hips in group B had a good outcome with Stulberg grades 1 or 2. Moderately and severely deformed hips on arthrography resulted in Stulberg 3 and 4 hips. None of the hips in Herring group C had a normal appearance at maturity and the outcome was not significantly influenced by the age at onset or the arthrographic appearance.

Concordância intra e interobservadores das diferentes classificações usadas na doença de Legg‐Calvé‐Perthes

“…5,12 Quando comparada com a classificação de Catterall, 3 a de Herring et al 5 é de mais fácil interpretação, mas, como também só pode ser usada na fase final de fragmentação, consideramos que não seja a ideal para se indicar o tratamento precoce. 12 Desde a descrição inicial da classificação, apresentada em 1994, em virtude da dificuldade de definir os pacientes …”

Varus-producing osteotomy for patients with lateral pillar type B and C Legg-Calvé-Perthes disease followed to skeletal maturity

“…While many theories on the etiology have been proposed and some causal relationships have been established [7][8][9][10][11][12], no single cause has been identified. It is clear that the disease affects boys more often than girls [13], and it is well known that the radiographic result of a flat head is associated with the development of early degenerative arthritis [5,[14][15][16][17][18][19][20][21][22]. The controversy surrounding the treatment of disease becomes understandable when the different strategies for it are numbered [22][23][24][25][26][27].…”

Treatment of severe late-onset Perthes’ disease with soft tissue release and articulated hip distraction: Revisited at skeletal maturity

“…These patients may develop a saddle-shaped subluxating femoral head that cannot be contained in the acetabulum. Since conservative treatment does not change the shape of the femoral head or affect joint congruency [2][3][4][5][6][7][8][9][10], different surgical treatment options have been proposed, including varus osteotomy (which may increase the incongruency) and valgus osteotomy (which may succeed in unloading the deformed part but may increase the subluxation without influencing the basic avascular process) [11][12][13]. Acetabular lateral shelf, Salter, Chiari, and triple osteotomies are considered salvage procedures at this age group that aim to reorient or increase the size of the acetabulum and produce more support to the femoral head [14][15][16][17][18].…”