Nationwide Norwegian prospective study of 368 children with unilateral Perthes' disease, followed for five years. It asked which radiographic factors predict outcome and whether physiotherapy, the Scottish Rite orthosis, or varus osteotomy work better. Outcome was graded by a modified three-group Stulberg classification.
Use head necrosis first: hips with less than 50% involvement did well no matter what, with zero Stulberg IV or V outcomes, so these can be managed with observation and physiotherapy.
The decision that changes management is in the older child with severe disease. In patients six years and older with more than 50% necrosis, varus osteotomy cut the flat-head (Stulberg C) rate to 11% versus roughly 40% for both non-operative options.
Under age six, do not over-treat. Outcomes were the same across all three treatments, reflecting the young hip's remodelling capacity before about age eight.
Timing matters: cover at diagnosis was not predictive, but cover at one year was. Since the lateral pillar grade is not reliable until early fragmentation, defer the treatment decision to around the six-month follow-up rather than committing at diagnosis. This study, alongside Herring's multicentre trial, supports abandoning the Scottish Rite abduction orthosis.
Nationwide Norwegian prospective study of 368 children with unilateral Perthes' disease, followed for five years. It asked which radiographic factors predict outcome and whether physiotherapy, the Scottish Rite orthosis, or varus osteotomy work better. Outcome was graded by a modified three-group Stulberg classification.
Use head necrosis first: hips with less than 50% involvement did well no matter what, with zero Stulberg IV or V outcomes, so these can be managed with observation and physiotherapy.
The decision that changes management is in the older child with severe disease. In patients six years and older with more than 50% necrosis, varus osteotomy cut the flat-head (Stulberg C) rate to 11% versus roughly 40% for both non-operative options.
Under age six, do not over-treat. Outcomes were the same across all three treatments, reflecting the young hip's remodelling capacity before about age eight.
Timing matters: cover at diagnosis was not predictive, but cover at one year was. Since the lateral pillar grade is not reliable until early fragmentation, defer the treatment decision to around the six-month follow-up rather than committing at diagnosis. This study, alongside Herring's multicentre trial, supports abandoning the Scottish Rite abduction orthosis.