Perthes disease: A survey of management amongst members of the British Society for Children's Orthopaedic Surgery (BSCOS)

Annamalai, Suresh; Buckingham, Rachel; Cashman, J. N.

doi:10.1007/s11832-007-0021-9

Cited by 12 publications

(9 citation statements)

References 20 publications

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“…In 2007, a survey was completed at a British Society of Children’s Orthopaedic Surgery (BSCOS) meeting to assess the variation of care regarding surgery in the UK, and described a large variability in the treatment chosen for children with Perthes’ disease. 13 The results of our case review 12 years later remain consistent with these survey findings, and further highlight the need for evidence and consensus in managing this disease.…”

Section: Discussionsupporting

confidence: 78%

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

et al. 2020

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Aims Perthes’ disease is a condition which leads to necrosis of the femoral head. It is most commonly reported in children aged four to nine years, with recent statistics suggesting it affects around five per 100,000 children in the UK. Current treatment for the condition aims to maintain the best possible environment for the disease process to run its natural course. Management typically includes physiotherapy with or without surgical intervention. Physiotherapy intervention often will include strengthening/stretching programmes, exercise/activity advice, and, in some centres, will include intervention, such as hydrotherapy. There is significant variation in care with no consensus on which treatment option is best. The importance of work in this area has been demonstrated by the British Society for Children’s Orthopaedic Surgery through the James Lind Alliance’s prioritization of work to determine/identify surgical versus non-surgical management of Perthes’ disease. It was identified as the fourth-highest priority for paediatric lower limb surgery research in 2018. Methods Five UK NHS centres, including those from the NEWS (North, East, West and South Yorkshire) orthopaedic group, contributed to this case review, with each entre providing clinical data from a minimum of five children. Information regarding both orthopaedic and physiotherapeutic management over a two-year post-diagnosis period was reviewed. Results Data were extracted from the clinical records of 32 children diagnosed with Perthes’ disease; seven boys and 25 girls. The mean age of the children at diagnosis was 6.16 years (standard deviation (SD) 3.001). In all, 26 children were referred for physiotherapy. In the two-year period following diagnosis, children were seen a median of 7.5 times (interquartile range (IQR) 4.25 to 11) by an orthopaedic surgeon, and a median of 9.5 times (IQR 8 to 18.25) by a physiotherapist. One centre had operated on all of their children, while another had operated on none. Overall, 17 (53%) of the children were managed conservatively in the two-year follow-up period, and 15 (47%) of the children underwent surgery in the two-year follow-up period. Conclusion The results of this case review demonstrate a variation of care provided to children in the UK with Perthes’ disease. Further national and international understanding of current care is required to underpin the rationale for different treatment options in children with Perthes’ disease. Cite this article: Bone Joint Open 2020;1-11:691–695.

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Section: Discussionsupporting

confidence: 78%

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

et al. 2020

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“…[1][2][3][4][5] This is often due to differences in opinion, which surgeons frequently accept because much of the literature underpinning practice is contradictory. 6 Another determinant is the poor quality of the evidence, which until recently almost universally involved observational case series.…”

Section: Cite This Article: Bone Joint J 2018;100-b:680-4mentioning

confidence: 99%

A consensus exercise identifying priorities for research into clinical effectiveness among children’s orthopaedic surgeons in the United Kingdom

Perry

Wright

Cooke

et al. 2018

The Bone & Joint Journal

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AimsHigh-quality clinical research in children's orthopaedic surgery has lagged behind other surgical subspecialties. This study used a consensus-based approach to identify research priorities for clinical trials in children's orthopaedics. MethodsA modified Delphi technique was used, which involved an initial scoping survey, a tworound Delphi process and an expert panel formed of members of the British Society of Children's Orthopaedic Surgery. The survey was conducted amongst orthopaedic surgeons treating children in the United Kingdom and Ireland. ResultsA total of 86 clinicians contributed to both rounds of the Delphi process, scoring priorities from one (low priority) to five (high priority). Elective topics were ranked higher than those relating to trauma, with the top ten elective research questions scoring higher than the top question for trauma. Ten elective, and five trauma research priorities were identified, with the three highest ranked questions relating to the treatment of slipped capital femoral epiphysis (mean score 4.6/ 5), Perthes' disease (4.5) and bone infection (4.5). ConclusionThis consensus-based research agenda will guide surgeons, academics and funders to improve the evidence in children's orthopaedic surgery and encourage the development of multicentre clinical trials.

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“…To se mo že po sti aei ab duk ci o nim or to za ma, va ri za ci o nom oste o to mi jom fe mu ra i oste o to mi ja ma ili jaè ne kosti (Sal te ro va, tro stru ka kod sta ri je de ce, Kja ri jeva kod kok se pla ne i osta lih slu èa je va gde se ne može po sti aei sfe riè na kon gru en ci ja zglo ba). Ne ka da je neo p hod no kom bi no va ti oste o to mi ju ili jaè ne kosti i fe mu ra [1][2][3][4][5][6][10][11][12][13][14][15][16][17][18][19][20].…”

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Legg-Calvé-Perthes disease: Diagnostics and contemporary treatment

et al. 2008

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Legg-Calvé-Perthes disease represents avascular necrosis of the femoral head in a growing child. It commonly affects children aged 2-14 years, mostly boys, and has familiar pattern. The etiology of this disease is unknown. It is based on avascular necrosis due to variations of the femoral head vascular supply, trauma, coagulation of endocrine disturbances. The disease presents with limping and pain localized in the hip with projection to thigh and knee, frequently accompanied by the limitation of abduction and internal rotation, as well as slight limitation in flexion of about 20 degrees. Plain radiography is most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage and the extent of disease. Main treatment goal is obtaining the spherical congruity of the hip joint. This can be achieved by abduction bracing, varization femoral osteotomies and various innominate osteotomies (sometimes combined with femoral osteotomies). Children younger than four years of age, with minimal femoral head involvement, do not need any treatment. These children with a larger involvement, older than four years of age, with possible containment in hip abducion, should be treated by one of the following procedures: Salter innominate osteotomy, Salter innominate osteotomy with femoral shortening, or triple pelvic osteotomy. The patients with containment of the hip is not possible in abduction (related to subluxation and femoral head crush), should be treated by Chiari pelvic osteotomy.

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Perthes disease: A survey of management amongst members of the British Society for Children's Orthopaedic Surgery (BSCOS)

Cited by 12 publications

References 20 publications

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

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

A consensus exercise identifying priorities for research into clinical effectiveness among children’s orthopaedic surgeons in the United Kingdom

Legg-Calvé-Perthes disease: Diagnostics and contemporary treatment

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