Wessex Gauvain Society Annual Meeting

Authors:
Laura Beddard, Robert Richards

Hospital:
Queen Alexandra Hospital

Introduction:
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.

Methods:
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.

Results:
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).

Conclusions:
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.