Perthes in Portsmouth: 27 years of experience

Laura Beddard, Robert Richards

Queen Alexandra Hospital

Various factors have been proposed to influence outcome in Perthes. Choosing which patients to operate on, and when can be a challenge.
We present a prospective cohort study aiming to identify correlation between timing of surgical treatment and outcome.

Prospective data was collected from a single centre between 28/11/1994 and 23/12/2021. Demographics, radiographic parameters, and surgical intervention were recorded on a database. Radiographic parameters recorded were Herring and Catterall grading at presentation, maximum fragmentation (Waldenstrom stage II) and Stulberg grade at skeletal maturity.

105 cases of Perthes were diagnosed in 99 patients. 66 hips have been followed up to maturity, 31 remain under review. The remaining 8 cases had incomplete data.
Children complained of symptoms at a median age of 4 years 8 months and were diagnosed on average 2 months later. The median time from the onset of symptoms to Waldenstrom stage II was 10 months.
32 hips (48%) underwent 52 open procedures. The mean time from symptoms to surgery was 18.4 months. The choice of operative intervention varied with age.
Four hips (12.5%) underwent surgery prior to reaching maximal fragmentation, 5 (16%) underwent surgery within the same month and 23 (72%) underwent surgery after this.
Stulberg grade tended to be higher in hips that underwent surgery after maximal fragmentation, although this was not statistically significant (p=0.35).

Earlier surgery is likely to lead to better radiological outcomes. Understanding timing between symptoms and maximal fragmentation helps plan follow up and intervention to achieve best outcomes.