Variation in assessment, diagnosis and outcome measurement in Perthes disease: a scoping review

Purpose: Perthes disease is a rare self-limiting avascular necrosis of the developing proximal capital femoral epiphysis. Identifying methods used to assess, diagnose and determine outcomes is essential to improve consistency in research and clinical care for this patient population. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews was used. Four electronic databases (Scopus, MEDLINE, CINAHL and Embase) were searched with articles included if clinical and radiological assessments were conducted on more than 10 participants, aged 0 to <18 years with Legg–Calvé–Perthes disease post 2004. Results: From 9145 records, 32 studies were included, identifying 16 clinical assessments, 23 radiological assessments, 10 diagnostic classifications and 22 outcome measures. Overall, 64% of outcome measures identified are not currently validated for children and adolescents. Conclusions: Substantial variability in the methods used to assess, diagnose and determine outcomes in children and adolescents with Perthes disease was identified. When coupled with limited use of validated paediatric measures, this inconsistency complicates clinical decision-making, reduces consistency in patient care and prevents comparability across studies. Establishing expert consensus to determine the most appropriate, accurate and child-specific measures is needed to enhance consistency in patient care, enable more robust outcome reporting and strengthen future research in Perthes disease. Significance of study: Significant variation in diagnostic, assessment and outcome measures for Perthes disease underscores the need for validated, child-specific tools to improve clinical decision-making, facilitate comparability across studies and strengthen future research. Level of evidence Level III, scoping review