Dan Perry, Legg-Calvé-Perthes and the BOSS Study

This week, we are focusing on Legg-Calvé-Perthes, a condition that continues to frustrate patients, parents, and clinicians despite being described over 115 years ago. I speak with Dan Perry, a pediatric orthopedic surgeon and NIHR research professor at Alder Hey Hospital in Liverpool, England.  We centered the conversation around the results of the British Orthopedic Society Surveillance Study, or BOSS study, on Perthes. We discussed the paper they published in 2022, looking at epidemiology in the United Kingdom. We talk about how dogma and not necessarily scientific evidence have influenced surgical Practice worldwide. He explains how they set up a prospective nested cohort of patients nationwide in the United Kingdom. We discuss the variability in treatment approaches and what led surgeons to intervene while others recommended nonoperative means. We talk about the importance of setting up randomized controlled trials but the inherent difficulties of doing so, especially with surgical interventions. We also look at future directions, amongst other things.