Age at diagnosis is a critical prognostic factor in unilateral Perthes' disease, with diagnosis after age 9 associated with poor long-term radiographic outcomes.
Answers are grounded in this paper and cite their sources.
Diagnosis after age 9 may indicate poor Stulberg outcomes in Perthes disease; leaves open Catterall classification utility and requires prospective validation.
We have attempted to identify the most important long-term prognostic factors in Perthes' disease by studying 61 patients affected unilaterally. The average age at diagnosis was 7 years 5 months and at follow-up it was 32 years, an average interval of 25 years. The age at diagnosis, age at follow-up, Catterall group, acetabular coverage, femoral head subluxation and the other head-at-risk signs were statistically correlated with Stulberg, Cooperman and Wallensten (1981) radiographic classes and the Iowa hip score. Statistically significant correlations were found between Stulberg class and Iowa hip score; age at diagnosis and Stulberg class; age at follow-up and Iowa hip score; and between lateral subluxation of the femoral head and Iowa hip score. Three age-groups of patients were found to carry different long-term prognoses. Those below five years of age at diagnosis showed a statistically significant correlation between Catterall group and Stulberg Classes I and II. Patients between five and nine years of age at diagnosis showed a significant correlation between Catterall group and Stulberg Classes I, II, III and IV while in patients diagnosed after nine years of age there was no statistical correlation between Catterall group and Stulberg class, all having a poor prognosis and ending up in Stulberg Classes III, IV and V.
No takes yet. Share an insight, caveat, or question.
Ippolito et al. (1987) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: