What is the long-term prognosis of Perthes' disease after conservative noncontainment treatment?
Long-term follow-up of Perthes' disease treated with conservative noncontainment shows a high rate of radiographic arthrosis and need for hip replacement, with age at diagnosis and femoral head shape at skeletal maturity being the most reliable prognostic factors.
The results in 96 patients (106 hips) with Perthes' disease who had had conservative noncontainment treatment were studied after 35 (28-47) years. At skeletal maturity, the radiographic result was poor in 65 hips. At the average age of 43 years, radiographic signs of arthrosis were found in 48 patients (51 hips); 5 patients had had hip replacement and 13 patients had symptoms justifying that procedure. At early phases of the disease, radiographs showed biocompartmentalization of the acetabulum in 24 percent of the hips, but the acetabulum normalized in the majority. There was no difference in long-term prognosis between Catterall's Groups III and IV; two or more signs of head-at-risk were not of prognostic value. The patients' age at diagnosis and the shape of the femoral head at skeletal maturity were the most reliable prognostic factors.
Timo Yrjönen (1992) studied this question.