The British Orthopaedic Surgery Surveillance study: Perthes’ disease

Abstract

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.

Positive outcome reporting in orthopaedic literature

“…Despite existing evidence highlighting which patients may benefit from surgery instead of conservative treatment, there are several surgical approaches within the literature, and most have positive reported outcomes. [18][19][20] Perry et al 32 conducted an anonymized comprehensive cohort study of Perthes' disease across 143 hospitals in the UK and reported considerable variation in how these patients were treated. In their study, despite a high proportion (36.4%) of patients undergoing surgical containment, the authors report no evidence of improved outcomes.…”

Public Insurance and Single-Guardian Households Are Associated with Diagnostic Delay in Slipped Capital Femoral Epiphysis

“…and physician specialty at the time of the initial presentation. As severity is thought to be a consequence of delay, the slip severity classification and Southwick angle measurement were not included as covariates in the models 4,5,9 . SCFE severity was assessed on anteroposterior and lateral radiographs by 2 authors (L.M.S.…”

“…increases the risks of osteonecrosis, chondrolysis, and advanced hip arthritis [9][10][11][12][13][14] .…”

Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg–Calvé–Perthes

“…176 Clinical trials are currently underway and their results awaited. 177 The recent study that casts doubt on the effectiveness of containment surgery 170 clearly emphasizes the urgent need to embark on well-designed, prospective studies with adequate follow-up (ideally randomized controlled trials (RCTs)) to clarify the role of the current approach to treatment of LCPD. Realizing the need for robust prospective studies, the International Perthes Study Group (IPSG) has begun collecting data prospectively and undertaking studies on various aspects of LCPD.…”