A case review to describe variation in care following diagnosis of Perthes' disease
Aims: Perthes’ disease is a condition which leads to necrosis of the femoral head. It is most commonly reported in children aged four to nine years, with recent statistics suggesting it affects around five per 100,000 children in the UK. Current treatment for the condition aims to maintain the best...
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2020-11-01
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doaj-286345c854fe47f5b40cf248c089ad692020-11-25T04:11:45ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622020-11-0111169169510.1302/2633-1462.111.BJO-2020-0139.R1A case review to describe variation in care following diagnosis of Perthes' diseaseAdam M. Galloway0Colin Holton1Varun Parnami2Michelle Wood3Joanna Craven4Nick Green5Heidi J. Siddle6Suzanne Richards7Christine Comer8Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UKLeeds Teaching Hospitals NHS Trust, Leeds, UKRoyal Manchester Children’s Hospital, Manchester, UKHull University Teaching Hospitals NHS Trust, Hull, UKAlder Hey Children’s Hospital NHS Foundation Trust, Liverpool, UKSheffield Children’s Hospital, Sheffield, UKLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UKInstitute of Health Science, University of Leeds, Leeds, UKLeeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UKAims: Perthes’ disease is a condition which leads to necrosis of the femoral head. It is most commonly reported in children aged four to nine years, with recent statistics suggesting it affects around five per 100,000 children in the UK. Current treatment for the condition aims to maintain the best possible environment for the disease process to run its natural course. Management typically includes physiotherapy with or without surgical intervention. Physiotherapy intervention often will include strengthening/stretching programmes, exercise/activity advice, and, in some centres, will include intervention, such as hydrotherapy. There is significant variation in care with no consensus on which treatment option is best. The importance of work in this area has been demonstrated by the British Society for Children’s Orthopaedic Surgery through the James Lind Alliance’s prioritization of work to determine/identify surgical versus non-surgical management of Perthes’ disease. It was identified as the fourth-highest priority for paediatric lower limb surgery research in 2018. Methods: Five UK NHS centres, including those from the NEWS (North, East, West and South Yorkshire) orthopaedic group, contributed to this case review, with each entre providing clinical data from a minimum of five children. Information regarding both orthopaedic and physiotherapeutic management over a two-year post-diagnosis period was reviewed. Results: Data were extracted from the clinical records of 32 children diagnosed with Perthes’ disease; seven boys and 25 girls. The mean age of the children at diagnosis was 6.16 years (standard deviation (SD) 3.001). In all, 26 children were referred for physiotherapy. In the two-year period following diagnosis, children were seen a median of 7.5 times (interquartile range (IQR) 4.25 to 11) by an orthopaedic surgeon, and a median of 9.5 times (IQR 8 to 18.25) by a physiotherapist. One centre had operated on all of their children, while another had operated on none. Overall, 17 (53%) of the children were managed conservatively in the two-year follow-up period, and 15 (47%) of the children underwent surgery in the two-year follow-up period. Conclusion: The results of this case review demonstrate a variation of care provided to children in the UK with Perthes’ disease. Further national and international understanding of current care is required to underpin the rationale for different treatment options in children with Perthes’ disease.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.111.BJO-2020-0139.R1paediatricspaediatric orthopaedicsperthes' diseaselegg-calve-perthesphysiotherapy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Adam M. Galloway Colin Holton Varun Parnami Michelle Wood Joanna Craven Nick Green Heidi J. Siddle Suzanne Richards Christine Comer |
spellingShingle |
Adam M. Galloway Colin Holton Varun Parnami Michelle Wood Joanna Craven Nick Green Heidi J. Siddle Suzanne Richards Christine Comer A case review to describe variation in care following diagnosis of Perthes' disease Bone & Joint Open paediatrics paediatric orthopaedics perthes' disease legg-calve-perthes physiotherapy |
author_facet |
Adam M. Galloway Colin Holton Varun Parnami Michelle Wood Joanna Craven Nick Green Heidi J. Siddle Suzanne Richards Christine Comer |
author_sort |
Adam M. Galloway |
title |
A case review to describe variation in care following diagnosis of Perthes' disease |
title_short |
A case review to describe variation in care following diagnosis of Perthes' disease |
title_full |
A case review to describe variation in care following diagnosis of Perthes' disease |
title_fullStr |
A case review to describe variation in care following diagnosis of Perthes' disease |
title_full_unstemmed |
A case review to describe variation in care following diagnosis of Perthes' disease |
title_sort |
case review to describe variation in care following diagnosis of perthes' disease |
publisher |
The British Editorial Society of Bone & Joint Surgery |
series |
Bone & Joint Open |
issn |
2633-1462 |
publishDate |
2020-11-01 |
description |
Aims: Perthes’ disease is a condition which leads to necrosis of the femoral head. It is most commonly reported in children aged four to nine years, with recent statistics suggesting it affects around five per 100,000 children in the UK. Current treatment for the condition aims to maintain the best possible environment for the disease process to run its natural course. Management typically includes physiotherapy with or without surgical intervention. Physiotherapy intervention often will include strengthening/stretching programmes, exercise/activity advice, and, in some centres, will include intervention, such as hydrotherapy. There is significant variation in care with no consensus on which treatment option is best. The importance of work in this area has been demonstrated by the British Society for Children’s Orthopaedic Surgery through the James Lind Alliance’s prioritization of work to determine/identify surgical versus non-surgical management of Perthes’ disease. It was identified as the fourth-highest priority for paediatric lower limb surgery research in 2018. Methods: Five UK NHS centres, including those from the NEWS (North, East, West and South Yorkshire) orthopaedic group, contributed to this case review, with each entre providing clinical data from a minimum of five children. Information regarding both orthopaedic and physiotherapeutic management over a two-year post-diagnosis period was reviewed. Results: Data were extracted from the clinical records of 32 children diagnosed with Perthes’ disease; seven boys and 25 girls. The mean age of the children at diagnosis was 6.16 years (standard deviation (SD) 3.001). In all, 26 children were referred for physiotherapy. In the two-year period following diagnosis, children were seen a median of 7.5 times (interquartile range (IQR) 4.25 to 11) by an orthopaedic surgeon, and a median of 9.5 times (IQR 8 to 18.25) by a physiotherapist. One centre had operated on all of their children, while another had operated on none. Overall, 17 (53%) of the children were managed conservatively in the two-year follow-up period, and 15 (47%) of the children underwent surgery in the two-year follow-up period. Conclusion: The results of this case review demonstrate a variation of care provided to children in the UK with Perthes’ disease. Further national and international understanding of current care is required to underpin the rationale for different treatment options in children with Perthes’ disease. |
topic |
paediatrics paediatric orthopaedics perthes' disease legg-calve-perthes physiotherapy |
url |
https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.111.BJO-2020-0139.R1 |
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