Results of three different therapeutic groups in Perthes' disease.

Three groups of patients with Legg-Calvé-Perthes disease (LCPD) were treated with the following 3 different methods of treatment: conservative treatment alone; immediate varus osteotomy; osteotomy alone when risk factors occurred. The best results were obtained by the immediate varus osteotomy operation. The risk factors were significantly less in this group. Immediate varus osteotomy probably avoids or reduces the occurrence of risk factors. Immediate osteotomy is not prescribed for all patients because in some the operation would be unnecessary. A good result is often possible by conservative treatment alone. As it is often difficult to classify the patients into the 4 standard groups defined by Catterall, at the time of onset of the disease, the age of the patient is a critical factor in the decision for conservative versus operative treatment. In our patients risk factors were significantly less in children younger than 6 years of age, and good results were found in 80% of these patients in Group I with conservative treatment alone. Since 1976, the following procedure has been used: conservative treatment (Thomas splint) in patients younger than 6 years of age; immediate varus osteotomy in the older patients.