The outcome and prognostic factors in children with bilateral Perthes' disease: a prospective study of 40 children with follow-up over five years.
2016
Aims The aims of this study were to describe the course of non-operatively
managed, bilateral Perthes’ disease, and to determine specific prognostic
factors for the radiographic and clinical outcome. Patients and Methods We identified 40 children with a mean age of 5.9 years (1.8 to
13.5), who were managed non-operatively for bilateral Perthes’ disease
from our prospective, multicentre study of this condition, which
included all children in Norway who were diagnosed with Perthes’
disease in the five-year period between 1996 and 2000. All children
were followed up for five years. The hips were classified according to the Catterall classification.
A modified three-group Stulberg classification was used as an outcome
measure, with a spherical femoral head being defined as a good outcome,
an oval head as fair, and a flat femoral head as a poor outcome. Results Concurrent, simultaneous bilateral Perthes’ disease was seen
in 23 children and 17 had the sequential onset of bilateral disease.
The mean delay in onset for the second hip in the latter group was
1.9 years (0.3 to 5.5). The five-year radiographic outcome was good in 30 (39%), fair
in 25 (33%) and poor in 21 (28%) of the hips. The strongest predictors
of poor outcome were > 50% necrosis of the femoral head, with odds
ratio (OR) 19.6, and age at diagnosis > 6 years (OR 3.3). Other
risk factors for poor outcome were the timing of the onset of disease,
where children with the sequential onset of bilateral disease had
a higher risk than those with the concurrent onset of bilateral
disease (p = 0.021, chi-squared test). Following a diagnosis of Perthes’ disease in one hip, there was
a 5% chance of developing it in the contralateral hip. Conclusion These results imply that we need to distinguish between children
with concurrent onset and those with sequential onset of bilateral
Perthes’ disease, as the outcomes may be different. This has not
been previously described. Children with concurrent onset of bilateral
disease had a similar outcome to our previous series of those with unilateral
disease, whereas children with sequential onset of bilateral disease
had a worse prognosis. The increased risk of developing Perthes’
disease in the contralateral hip in those with unilateral disease
is important information for the child and parents. Cite this article: Bone Joint J 2016;98-B:569–75.
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