What is the prognosis for a 35-year-old male with a history of stage 4 Legg-Calve-Perthes (LCP) disease treated with osteotomy and immobilization as a child?

Prognosis for a 35-Year-Old Male with History of Stage 4 Perthes Disease Treated with Osteotomy and Immobilization

Adults with a history of stage 4 Legg-Calvé-Perthes disease treated in childhood with osteotomy and immobilization are likely to develop degenerative hip arthritis by middle age, with approximately 50% showing radiographic signs of arthrosis by their early 40s.

Long-Term Outcomes After Childhood Perthes Disease

Prognostic Factors

• Age at diagnosis: The patient was diagnosed at 5 years old, which is generally associated with better outcomes compared to later diagnosis
• Disease severity: Stage 4 (equivalent to Catterall Group IV) represents severe involvement with complete femoral head necrosis
• Treatment received: Osteotomy with immobilization represents appropriate surgical containment treatment

Expected Outcomes at Age 35

1. Radiographic changes:

   • Likely to show some degree of femoral head deformity
   • Early to moderate degenerative changes in the hip joint
   • Possible acetabular changes secondary to the femoral head deformity

2. Functional status:

   • Moderate limitation in hip range of motion
   • Increased risk of hip pain with activities
   • Possible limb length discrepancy (average 0.9 cm shortening on the affected side) 1

Evidence-Based Prognosis

Long-term follow-up studies show that patients with severe Perthes disease (Catterall Group IV) have a high likelihood of developing degenerative changes by middle age:

• In a 28-47 year follow-up study, approximately 48% of patients showed radiographic signs of arthrosis at an average age of 43 years 2
• About 19% of patients had either undergone hip replacement or had symptoms severe enough to justify the procedure 2
• The shape of the femoral head at skeletal maturity is the most reliable prognostic factor for long-term outcomes 2

Musculoskeletal Complications

Adults with a history of childhood Perthes disease commonly experience:

• Pain: Typically activity-related hip pain that may worsen with age
• Mobility limitations: Decreased hip range of motion, particularly internal rotation and abduction
• Muscle weakness: Reduced strength in hip abductors and flexors 3
• Fatigue: Increased energy expenditure during walking due to altered biomechanics
• Risk of early osteoarthritis: Higher than the general population

Management Considerations at Age 35

Monitoring

• Regular clinical and radiographic assessment to monitor progression of degenerative changes
• Evaluation of pain, function, and quality of life

Conservative Management

• Physical therapy: Focus on maintaining joint range of motion, muscle strength, and endurance 3
• Weight management: Critical to reduce mechanical stress on the affected hip
• Activity modification: Avoiding high-impact activities that exacerbate symptoms

Surgical Considerations

• Total hip arthroplasty may eventually be required if degenerative changes progress and cause significant pain and functional limitation
• The timing of arthroplasty should be based on symptom severity and functional impairment rather than age alone

Factors That May Improve Prognosis

• Early treatment (at age 5) is favorable compared to treatment after age 6
• Surgical containment with osteotomy likely improved femoral head coverage and may have enhanced remodeling during growth 4
• Maintenance of good hip range of motion and muscle strength through adulthood

Factors That May Worsen Prognosis

• Stage 4 (Catterall IV) disease carries a worse prognosis regardless of treatment method 5
• Development of secondary impingement or labral pathology
• Obesity or high-impact activities that increase mechanical stress on the hip joint

Conclusion

While early surgical intervention likely improved outcomes compared to the natural history of untreated severe Perthes disease, the patient still faces a significant risk of progressive hip degeneration. By age 35, some degree of degenerative change is likely present, though it may not yet be symptomatic. The next 5-15 years represent a critical period when symptoms may progress, potentially necessitating more aggressive interventions including hip arthroplasty.