Comparison of radiological results of conservative and operative treatment by Salter osteotomy in severe cases of Perthes' disease.

Background. The goal of treatment in Perthes' disease is the creation of best conditions for good hip reconstruction. The aim of this work was the comparison of radiological results of conservative and operative treatment by Salter osteotomy in Perthes' disease. Material and methods. 193 hips with severe Perthes' disease were analyzed (Catterall group III, IV), 105 hips were treated conservatively, 88 - were operated. Minimal follow-up time was 5 years. Following data were evaluated: Wiberg angle, acetabular angle, acetabulum-head index, acetabular and epiphyseal index. Additionally, head sphericity according to Mose, results estimation according to Stulberg and presence of arthritic changes were evaluated. Results. In conservative treatment group, Mose good result was achieved in 25 hips (23,8%), fair result - in 54 (51,4%), and poor result - in 26 (24,8%). According to Stulberg classification, class I was in 25 hips (23,8%), class II - 37 (35,2%), class III - 28 (26,7%), class IV - 9 (8,6%), class V - 6 (5,7%). In operative treatment group, Mose good result was achieved in 45 hips (51,2%), fair result - in 19 (21,6%), and poor result - in 24 (27,2%). According to Stulberg classification, class I was in 39 hips (44,3%), class II - 26 (29,5%), class III - 13 14,7%), class IV - 8 (9,1%), class V - 2 (2,3%). Radiological parameters of femoral head coverage were better after operative treatment. The amount of arthritic changes after conservative treatment were greater than after surgery. Conclusions. 1. Operative treatment by Salter osteotomy creates better conditions for spherical femoral head reconstruction. 2. Patients with III and IV Catterall group should be treated surgically.