The surgical treatment of children with Perthes' disease: 26 years of experience.

Background. The purpose of this article is to present the history of the authors' own technique for the surgical treatment of children with Perthes' disease by means of inter- and subtrochanteric osteotomy, and to describe the outcomes achieved. Material and methods. We analyzed 208 hip joints treated during the period 1976-1998 (162 boys and 46 girls, m/f ratio 78/22). The average age at surgery was 7.8 years, and at final check-up, 13 years; the average observation period was 11 years (range 5-25). After surgery the children were immobilized in a plaster cast for 8 weeks, and then for 8 more weeks in an exercise cast. Results. We analyzed the results, assessed according to the Stulberg and Mose systems, in 3 age groups with differing outcome. In the 3-5 years age bracket there were 81% good outcomes, 22% satisfactory, and 5% poor. In the 6-8 age bracket, there were 77% good outcomes, 18% satisfactory, and 5% poor. In the 9-14 age bracket we found 50% good outcomes, 40% satisfactory, and 10% poor. Conclusions. In 60% of the children operated in the early phase of the disease we observed cessation of the disease process and accelerated healing of the necrosis in the femoral head. These joints either did not pass through a fragmentation phase or only entered it. The outcomes we achieved and the short period of immobilization in plaster cast are good reasons to recommend this type of treatment.