A case review to describe variation in care following diagnosis of Perthes disease

Galloway, A.; Holton, Colin; Parnami, Varun; Wood, Michelle; Craven, Joanna; Green, N.; Siddle, Heidi J.; Richards, S H; Comer, Christine

doi:10.1016/j.physio.2021.10.088

Cited by 1 publication

(1 citation statement)

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“…The incidence is believed to be approximately five per 100,000 zero-to 14-year-olds per year, 4,5 suggesting that there are approximately 500 new cases throughout the uK annually. The origins of the disease are very closely linked to socioeconomic deprivation, 2,[5][6][7] though the aetiology and mechanism are so far unknown.…”

Section: Discussionmentioning

confidence: 99%

The British Orthopaedic Surgery Surveillance study: Perthes’ disease

Perry

Arch

Appelbe

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to evaluate the epidemiology and treatment of Perthes’ disease of the hip. Methods This was an anonymized comprehensive cohort study of Perthes’ disease, with a nested consented cohort. A total of 143 of 144 hospitals treating children’s hip disease in the UK participated over an 18-month period. Cases were cross-checked using a secondary independent reporting network of trainee surgeons to minimize those missing. Clinician-reported outcomes were collected until two years. Patient-reported outcome measures (PROMs) were collected for a subset of participants. Results Overall, 371 children (396 hips) were newly affected by Perthes’ disease arising from 63 hospitals, with a median of two patients (interquartile range 1.0 to 5.5) per hospital. The annual incidence was 2.48 patients (95% confidence interval (CI) 2.20 to 2.76) per 100,000 zero- to 14-year-olds. Of these, 117 hips (36.4%) were treated surgically. There was considerable variation in the treatment strategy, and an optimized decision tree identified joint stiffness and age above eight years as the key determinants for containment surgery. A total of 348 hips (88.5%) had outcomes to two years, of which 227 were in the late reossification stage for which a hip shape outcome (Stulberg grade) was assigned. The independent predictors of a poorer radiological outcome were female sex (odds ratio (OR) 2.27 (95% CI 1.19 to 4.35)), age above six years (OR 2.62 (95% CI (1.30 to 5.28)), and over 50% radiological collapse at inclusion (OR 2.19 (95% CI 0.99 to 4.83)). Surgery had no effect on radiological outcomes (OR 1.03 (95% CI 0.55 to 1.96)). PROMs indicated the marked effect of the disease on the child, which persisted at two years. Conclusion Despite the frequency of containment surgery, we found no evidence of improved outcomes. There appears to be a sufficient case volume and community equipoise among surgeons to embark on a randomized clinical trial to definitively investigate the effectiveness of containment surgery. Cite this article: Bone Joint J 2022;104-B(4):510–518.

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