A comparative analysis of conservative and surgical treatment of Perthes' disease.

Background. The choice of treatment method for Perthes' disease is still a frequently encountered dilemma in orthopedic practice. The aim of our research was to compare outcomes after conservative and surgical treatment in patients with Perthes' disease. Material and methods. 72 children with Perthes' disease were included in the study group, of whom 29 were treated surgically. The outcome was evaluated by means of radiological parameters: the Wiberg angle, the femoral head sphericity according to Mose, the femoral antetorsion angle, and the cervical-metaphyseal angle. Results. The Wiberg angle at follow-up was significantly greater after surgical treatment, while the deviation from sphericity of the femur in the affected joint was significantly less. Sphericity of the femoral head was also significantly less in patients treated conservatively, but not as much so. The antetorsion angle was significantly smaller after surgery than before, but did not differ significantly in patients treated conservatively. The cervial-metaphyseal angle in the affected limb at check-up was signficantly less in patients treated surgically, but not in those treated conservatively. Conclusions. Surgical treatment gave considerably more "good" outcomes than did conservative methods. Femoral osteotomy is a good method of treatment for Perthes's disease, if performed at the right stage in the development of the disease.