The effect of the therapeutic approach on the course of Perthes' disease and its outcome: Conservative vs. surgical treatment.

Background. The aim of our study was to compare the outcome of Perthes' disease in children treated conservatively or surgically, and to attempt to answer the question as to whether surgery shortens the duration of the disease and its treatment. Material and methods. We reviewed the clinical records of 61 children with Perthes disease (68 hips) from the years 1990-1994 were reviewed. There were 11 girls and 50 boys, the mean age at the onset of the disease was 5.3 years (range from 1.6 to 12.7), and the mean follow-up was 7.8 years (from 4.2 to 10.3). 36 hips underwent surgery (Dega transiliac osteotomy combined with an interrtrochanteric osteotomy of the femur). The remaining 32 hips were treated conservatively with various methods. The Catterall and Herring classification schemes were applied for the radiological assessment of the involvement of the femoral head, and the outcomes were evaluated using Stulberg's classification. Results and Conclusions. The mean time from the onset of the disease to full weight bearing was 20 months (range from 5 to 56) in the operated hips, and 20 months (range from 5 to 51) in the non-operated hips. There was no statistically significant correlation between the end results of the conservative and operative treatment for each group assessed according to the Catterall or Herring classification schemes. However, it should be borne in mind that the operated hips were initially classified as more involved than the non-operated ones.