Prospective multicenter cohort of 438 patients (451 hips) with Legg-Calvé-Perthes disease, ages 6-12 at onset, followed to skeletal maturity. Five treatment groups — observation, range-of-motion, Atlanta Scottish Rite bracing, femoral varus osteotomy, and innominate osteotomy — were compared to determine whether treatment alters outcome and which patient factors predict it. All hips were classified by the lateral pillar system and graded at maturity by the Stulberg classification.
Two variables decide almost everything in Perthes: lateral pillar group and age at onset. This prospective study of 345 hips followed to skeletal maturity is the largest controlled evidence base ever assembled for this disease, replacing decades of small retrospective series that could not agree on whether treatment mattered.
When you see a child with Perthes, determine the lateral pillar group first. Group A hips need symptomatic care only. Group C hips have poor outcomes regardless of what you do — set expectations accordingly and avoid subjecting these children to osteotomy without clear benefit.
For lateral pillar B and B/C border hips, age 8 is the pivot point. Children 8 and under do well without surgery. Children over 8 with these classifications should be offered surgical containment (either femoral varus osteotomy or innominate osteotomy. Outcomes are equivalent). This is the decision rule that anchors every modern Perthes algorithm.
The finding that bracing performs no better than observation effectively ended routine use of the Atlanta Scottish Rite orthosis for this indication. If a family asks about the brace, the answer from this data is clear.
Prospective multicenter cohort of 438 patients (451 hips) with Legg-Calvé-Perthes disease, ages 6-12 at onset, followed to skeletal maturity. Five treatment groups — observation, range-of-motion, Atlanta Scottish Rite bracing, femoral varus osteotomy, and innominate osteotomy — were compared to determine whether treatment alters outcome and which patient factors predict it. All hips were classified by the lateral pillar system and graded at maturity by the Stulberg classification.
Two variables decide almost everything in Perthes: lateral pillar group and age at onset. This prospective study of 345 hips followed to skeletal maturity is the largest controlled evidence base ever assembled for this disease, replacing decades of small retrospective series that could not agree on whether treatment mattered.
When you see a child with Perthes, determine the lateral pillar group first. Group A hips need symptomatic care only. Group C hips have poor outcomes regardless of what you do — set expectations accordingly and avoid subjecting these children to osteotomy without clear benefit.
For lateral pillar B and B/C border hips, age 8 is the pivot point. Children 8 and under do well without surgery. Children over 8 with these classifications should be offered surgical containment (either femoral varus osteotomy or innominate osteotomy. Outcomes are equivalent). This is the decision rule that anchors every modern Perthes algorithm.
The finding that bracing performs no better than observation effectively ended routine use of the Atlanta Scottish Rite orthosis for this indication. If a family asks about the brace, the answer from this data is clear.