Publication: Clinical audit on perthes disease treatment in Hospital Universiti Sains Malaysia for past 20 years
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Date
2022
Authors
Ibrahim, Mohd Azahari
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Abstract
Introduction Perthes disease is avascular necrosis of femoral head due to unknown cause. The spontaneous revascularisation will cause femoral head to be soft and possible deformed. The outcome of the disease will depend on severity of disease as well as how and when the treatment are provided. We review all the cases treated in our institution to know the pattern of presentation and outcome of treatment. Methodology We reviewed all Perthes disease patients treated in our hospital from 2000 -2020. Patients were traced based on International Classification of Disease, 10th Revision (ICD -10). The required clinical information was obtained from patients record and General Healthcare Centricitytm picture archiving communication system (PACS). Phone interview was used to asceses the hip symptom. The information was scrutinized and presented with descriptive manner. Results Out of 32 patients(34 hips) , there were only 2 patients presented with disease of both hips and only 2 patients were female. Age of presentation varies from 4-12 years and 19 (59.4%) of them were 8 years or older. Five patients presented with hinge abduction. Two patients presented at ischemic phase, 29 patients presented at fragmentation phase and one patient presented at late fragmentation phase of the disease. Four hips presented with Herring A, 16 patients presented with Herring B and 14 presented Herring C. Out of 22 hips who were followed up until maturity, 7 hips had Stulberg A, 12 hips had Stulberg B and 3 hips had Stulberg C. Out of fourteen patients with femoral varus osteotomy (FVO) for containment procedure and followed up until maturity, 5 patients had Stulberg A and 9 patients had Stulberg B and no patient had Stulberg C. Out of two patients underwent arthrodiastasis for containment, one resulted with Stulberg B and another patient resulted with Stulberg C. Ten patients (12 hips) that were treated with non-operative treatment did not show consistent outcome . Among 5 patients with hinge abduction, 4 of them were containable under general anaesthesia and treated with FVO. One patient could not be contained under general anaesthesia and treated with arthrodiastasis. All of them had Stulberg B at maturity. Out of 21 patients with radiograph at maturity, 18 patients with Herring B of C had greater trochanter overgrowth of more than 0.5 cm and the remaining 3 patient with Herring A did not have greater trochanteric overgrowth. Conclusion There were bigger number of patients with late onset compare to early onset . FVO produces a reasonable outcome even in patient of older than 8 years old. Containment with panthaloon cast abduction brace produce unpredictable outcome. Patients with hinge abduction benefit FVO if the hips become containable with traction and adductor release. Prophylaxis by mean of greater trochanter epiphysiodesis depends on the method and age of patient.
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Keywords
Herring lateral pillar , Greater trochanteric overgrowth