growth after severe. Perthes' disease. (Catterall grade III or. IV) by retrospective analysis of serial radiographs in 52 hips (46 patients). Our aim was to determine.
ABNORMALITIES
OF
AFTER PAUL
SEVERE
D. SPONSELLER,
We studied
the pattern
by retrospective
femoral
of serial
Hospital
growth
radiographs
after
relationship between proximal femoral growth abnormalities physeal narrowing, and extensive epiphyseal necrosis. The (range
4 to 16 years),
Slowing asymmetrical seen in only
and 37 of the hips
were
disease femoral
addressed outcome
is recognised epiphysis.
changes has been
and congruency 198 1). However,
metaphysis but these 1980; Bowen, Foster
as primarily Most reports
involving the have therefore
Cooperman and Wallensten also occur in the physis and the
have rarely and Hartzel!
been discussed 1984).
(Barnes
Bowen et a! (1984) proposed two types of physeal growth abnormality secondary to Perthes’ disease: symmetrical (central) and asymmetrical (lateral), and stated growth
that both of these plate. They observed
21% of hips and the type and could metaphysea!
in their ofgrowth
involve early one of these
study, plate
P. D. Sponseller, MD, Assistant Professor The Johns Hopkins Medical Institution, Baltimore, Maryland 21205, USA. S. S. Desai, MD, Orthopaedic Maimonides Medical Center, York 1 1219, USA.
closure of two patterns
and felt that abnormality
be predicted by the following ‘cyst’ formation, narrowing
Resident 4802
600
©
should
be sent
factors : extensive of the physis in
North
610
Wolfe
Avenue,
Brooklyn,
Drive,
to Dr P. D. Sponseller.
1989 British Editorial Society of Bone 0301-620X/89/41 36 $2.00 J Bone Joint Surg [Br] 1989;7 1-B :610-4.
the in
the occurrence correlated with
M. B. Millis, MD, Attending Orthopaedic Surgeon The Children’s Hospital of Boston, 300 Longwood Massachusetts02ll5, USA. Correspondence
and
Joint
(46
Perthes’
disease
patients).
average
to skeletal
(Catterall
grade
III or
aim was to determine
Our
and metaphyseal
the
cysts, epiphyseal extrusion, after treatment was 9.8 years
follow-up maturity.
Street,
the
Surgery
New
Boston,
narrowing nor specific
disease,
marked
during the active stage of the predictors of the subsequent
extrusion
and
greater than 50% We have studied factors with physea! patients, all of whom
of the
PATIENTS We
retrospectively
femora!
epiphysis,
necrosis of the epiphysis. the correlation of the first three growth disturbance in a group of had greater than 50% epiphysea!
necrosis (Catterall (1971) grade view to more accurate prognosis
III and
AND analysed
or grade planning
IV), with for surgery.
a
METHODS the
notes
and
radiographs
of all patients undergoing femora! or innominate osteotomies for Perthes’ disease involving more than one half of the epiphysis seen at the Children’s Hospital, Boston, between 1967 and 1982. Ninety-five patients met these criteria; 88 (93%) were located and evaluated for current follow-up. The 40 patients who were treated by femora! osteotomy were excluded from the study because the effects of this procedure could not have been differentiated from the disease involved
Tenth
of Boston
extrusion and physeal to be neither sensitive
in this region, since the long-term shown to be related to its sphericity (Stulberg, changes
B. MILLIS
growth was common: symmetrical abnormality was seen in 26 hips and However, definite premature closure of the proximal femoral physis was seemed to be due to altered growth velocity rather than to bar formation
of proximal femoral abnormality in nine. three hips. Abnormality
in most cases. Metaphyseal cysts, epiphyseal disease, alone or in combination, were found growth pattern.
Perthes’ proximal
followed
MICHAEL
severe
in 52 hips
GROWTH
DISEASE
S. DESAI,
the Children’s
of proximal
analysis
FEMORAL
PERTHES’
SHEKHAR
From
IV)
PROXIMAL
hips
physea! process had
growth itself. been
treated
abnormalities Forty-six
secondary patients with
by innominate
to 46
osteotomy;
six of them had Perthes’ disease of the contra!ateral hip treated by orthotic containment. These 52 hips formed the series for the present study (Table I). Serial radiographs throughout the stage of epiphyseal involvement were available for all the these were analysed by two of the authors factors extrusion
listed above : growth and metaphysea!
THE
JOURNAL
plate ‘cysts’.
patients for the
and risk
narrowing, epiphyseal Cysts were defined
OF BONE
AND
JOINT
SURGERY
as
ABNORMALITIES
Table
1. Radiographic
analysis
of 52 hips
OF PROXIMAL
with
Perthes’
Epiphyseal extrusion
FEMORAL
GROWTH
AFTER
SEVERE
PERTHES
DISEASE
611
disease Difference
in millimetrest
MTV+
MTH
Growth
disturbance
Catterall grade
Size (%) and location ofcyst
I
3
