McAndrew and Weinstein followed 35 patients (37 hips) with Legg-Calvé-Perthes disease diagnosed 1920–1940 for an average of 47.7 years. The study asks which early clinical and radiographic factors predict who will eventually need hip replacement or suffer disabling dysfunction.
A child presenting with Perthes disease at age 9 faces a fundamentally different prognosis than one presenting at age 6 — and this paper gives you the numbers to explain why.
When counseling families, age at onset below 8 years is the most important prognostic factor you have. Only one-third of early-onset patients will suffer significant functional decline, compared to three-quarters of those presenting at age 8 or older.
When reviewing initial radiographs, do not rely on the Catterall grade alone. Count the head-at-risk signs: two or more signs predicts poor long-term outcome regardless of the Catterall class assigned. The head-size ratio and any joint space narrowing are the other two parameters worth tracking over time.
For patient counseling at the time of diagnosis: roughly half of all Perthes patients will have disabling osteoarthrosis by their 50s, and a small subset will need arthroplasty as early as their 30s. This paper is why Perthes is not a 'self-limited childhood disease'. It is a lifelong hip condition, and the trajectory is largely set at onset.
McAndrew and Weinstein followed 35 patients (37 hips) with Legg-Calvé-Perthes disease diagnosed 1920–1940 for an average of 47.7 years. The study asks which early clinical and radiographic factors predict who will eventually need hip replacement or suffer disabling dysfunction.
A child presenting with Perthes disease at age 9 faces a fundamentally different prognosis than one presenting at age 6 — and this paper gives you the numbers to explain why.
When counseling families, age at onset below 8 years is the most important prognostic factor you have. Only one-third of early-onset patients will suffer significant functional decline, compared to three-quarters of those presenting at age 8 or older.
When reviewing initial radiographs, do not rely on the Catterall grade alone. Count the head-at-risk signs: two or more signs predicts poor long-term outcome regardless of the Catterall class assigned. The head-size ratio and any joint space narrowing are the other two parameters worth tracking over time.
For patient counseling at the time of diagnosis: roughly half of all Perthes patients will have disabling osteoarthrosis by their 50s, and a small subset will need arthroplasty as early as their 30s. This paper is why Perthes is not a 'self-limited childhood disease'. It is a lifelong hip condition, and the trajectory is largely set at onset.