Tag Archive for: Catterall

Validation of Catterall Classification in the Management of Legg-CalvePerthes Disease

Volume 5 | Issue 1 | Jan-Apr 2019 | Page: 20-24 | B Pasupathy, Suresh Babu, M. Sathish

Authors : B. Pasupathy [1], Suresh Babu [1], M. Sathish [1]

[1] Department of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai

Address of Correspondence
Dr. M.Sathish,

Institute of Orthopaedics and Traumatology, Rajiv Gandhi Government General Hospital, Chennai – 03.



Introduction: Despite the advancement in the recent times, there is still no consensus about the ideal classification that could grade the patient with Perthes disease preoperatively and prognosticate its outcome on follow-up. Although principal dictum in the management of Perthes disease is to contain the femoral head in the acetabular socket to prevent deformation of the femoral head, method of containment and candidate selection for surgery depends on the stage of presentation of the disease where classification system plays a major role. The aim of our study to is validate the role of Catterall classification in grading the disease preoperatively and prognosticating its outcome and categorising the post op outcome by Catterall postoperative scale.

Materials & methods: This is a prospective study done from 2014-2018 where 72 children with Perthes disease were categorised and managed based on the Catterall classification and outcome was analysed. Surgical containment by varus derotation osteotomy was done in all patients presenting late and with severe disease and in patients with head at risk signs.

Results: Mean age of presentation was 7.4 years and out of 72 children, 26 belonged to grade 2 and 32, 14 belonged to grade 3 and 4 respectively. Surgical containment was done in 68 patients and in all patients containment was maintained till last follow-up. At a mean follow up of 2.4 years, good results were obtained in 49, fair in 21 and poor in 3 children using Catterall’s postoperative classification. Radiological evaluation was done using Caput Index and Epiphyseal Quotient to assess the regenerative potential of the femoral head. Statistical analysis revealed significant results on follow up, with earlier grades having significantly better outcome compared to the late stage of disease.

Conclusion: We concluded from our study that Catterall classification was consistent in prognosticating better outcome in patients presenting with low grade at early age and ideally selecting patients for surgical containment for advanced disease. Our study suggests that varus derotation osteotomy is an effective and easy surgical containment method for children with advanced disease that significantly altered the natural history of this self-limiting pathology.

Keywords: Legg Calve Perthes Disease, Classification, Catterall


1. Legg AT. An obscure affection of the hip joint. 1910. ClinOrthopRelat Res 2006;451:11-3.

2. Calve J. On a particular form of pseudo-coxalgia associated with a characteristic deformity of the upper end of the femur. 1910. ClinOrthopRelat Res 2006;451:146.

3. Perthes G. The classic: On juvenile arthritis deformans. 1910. ClinOrthopRelat Res 2012;470:2349-68.

4. Wenger DR, Pandya NK. A brief history of Legg-calve-Perthes disease. J PediatrOrthop 2011;31 2 Supp l:S130-6.

5. Kim HK, Herring JA. Pathophysiology, classifications, and natural history of Perthes disease. OrthopClin North Am 2011;42:285-295, v.

6. Kuo KN, Wu KW, Smith PA, Shih SF, Altiok H. Classification of Legg-calvePerthes disease. J PediatrOrthop 2011;31 2 Supp l:S168-73.

7. Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-calvePerthes disease. J Bone Joint Surg Am 1981;63:1095-108.

8. Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg Br 1971;53:37-53.

9. Salter RB, Thompson GH. Legg-calve-perthes disease: The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am 1984;66:479-89.

10. Mahadeva D, Chong M, Langton DJ, Turner AM. Reliability and reproducibility of classification systems for Legg-Calve-Perthes disease: A systematic review of the literature. ActaOrthopBelg 2010;76:48-57.

11. Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH. The lateral pillar classification of Legg-Calvé-Perthes disease. J PediatrOrthop 1992;12:143-50.

12. Farsetti P, Tudisco C, Caterini R, Potenza V, Ippolito E. The herring lateral pillar classification for prognosis in perthes disease: Late results in 49 patients treated conservatively. J Bone Joint Surg Br 1995;77:739-42.

13. Kim HK. Legg-Calve-Perthes disease. J Am AcadOrthopSurg 2010;18:676-86.

14. Saini R, Goyal T, Dhillon MS, Gill SS, Sudesh P, Mootha A. Outcome of varusderotation closed wedge osteotomy in Perthes disease. ActaOrthopBelg 2009;75:334-9.

15. Noonan KJ, Price CT, Kupiszewski SJ. Results of femoral varus osteotomy in children older than 9 years of age with Perthes disease. J PediatrOrthop 2001;21:198-204.

16. Dickens DR, Menelaus MB. The assessment of prognosis in Perthes’ disease. J Bone Joint Surg Br 1978;60-B:189-94.

17. Mose K. Methods of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis. ClinOrthopRelat Res 1980;150:103-9.

18. Shigeno Y, Evans GA. Revised arthrographic index of deformity for Perthes’ disease. J PediatrOrthop B 1996;5:44-7.

19. Cho TJ, Lee SH, Choi IH, Chung CY, Yoo WJ, Kim SJ. Femoral head deformity in Catterall groups III and IV Legg-Calvé- Perthes disease: Magnetic resonance image analysis in coronal and sagittal planes. J PediatrOrthop 2002;22:601-6.

20. Fredensborg N. The spherical index. A measure of the roundness of the femoral head. ActaRadiolDiagn (Stockh) 1977;18:685-8.

21. Heyman CH, Herndon CH. Legg-Perthes disease: A method for the measurement of the roentgenographic result. J Bone Joint Surg Am 1950;32 A:76778.

22. Joseph B, Srinivas G, Thomas R. Management of Perthes disease of late onset in Southern India. The evaluation of a surgical method. J Bone Joint Surg Br 1996;78:625-30.

23. Langenskiöld A. Changes in the capital growth plate and the proximal femoral metaphysis in Legg-Calvé-Perthes disease. ClinOrthopRelat Res 1980;150:110-4.

24. Matan AJ, Stevens PM, Smith JT, Santora SD. Combination trochanteric arrest and intertrochanteric osteotomy for Perthes’ disease. J PediatrOrthop 1996;16:104.

25. Skaggs DL, Tolo VT. Legg-Calve-Perthes disease. J Am AcadOrthopSurg 1996;4:9-16.

How to Cite this Article: Pasupathy B, Babu S, Sathish M. Validation of Catterall Classification in the Management of Legg-Calve-Perthes Disease. International Journal of Paediatric Orthopaedics Jan-April 2019;5(1): 24.

(Abstract)      (Full Text HTML)      (Download PDF)