Surgical Treatment for Perthes Disease

1. Surgical Treatment for Perthes Disease Mazloumi MD Associated professor Orthopaedic surgeon

2. A 14-year-old boy who had Legg-Calve´-Perthes disease at age 8 years and was treated with nonoperative methods

3. Pathomechanical environment • Structural instability • Femoroacetabularimpingment • Articular incongruity (localized joint overload) • Abductor inefficiency (articular overload) • Combinations

4. Perthes deformities Proximal femur ( spectrom and variabilities of deformities) • Large and aspherical femoral head • High grater throchanter (over growth) • Short femoral neck • Head neck offset deformity • Varus neck- shaft angle • Osteochondral disease

5. Perthes deformities Acetabulom ( spectrom and variabilities of deformities) • Decreseadeanterolateral and/or posterolateral femoral head coverage. • Increased acetabular inclination. • Relative acetabular deficiency. • Variable acetabular version

6. Long term outcome of Legg-Calve-perthes at middle age • Risk of sever OA and clinically poor outcome after 40-50 years of age irrespective of prior successful surgical treatment and good outcome at skeletal maturity • Increased incidence of OA and THA in patients with a Stulberg class III / IV / V who were treated with conservative methods

7. Surgical approaches for treatment of sequelaeof Perthes disease • Extraarticular methods • Intertrochantericvalgusosteotomy • 1- Valgus extension: best corrects limb deformity • 2- Valgus flexion: may better correct anterior impingement • Trochanteric transfer with relative neck lengthening To correct greater trochanteric abutment) • Noncontainmentacetabular procedures • 1- Shelf acetabuloplasty • 2- Chiari procedure • Intraarticular methods • Osteochondroplasty of the head and neck (open or via arthroscopy) • Note: residual dysplasia may also require treatment • Femoral head reduction (central “downsizing”) Unproved method • Excision of osteochondritisdissecans • Labral repair

11. Proximal femoral varusosteotomy

12. Proximal femoral valgusosteotomy

13. Valgusosteotomy

14. Triple pelvic osteotomy

15. Triple ost.

16. Double-level osteotomy

17. Shelf acetabuloplasty

18. Chiariosteotomy

19. Greater trochanteric advancement

20. Biomechanical effect of coxabreva

21. Coxabreva

22. Neck lengthening

24. Morscherosteotomy

25. Morscherosteotomy

27. biomechanical effects of the surgical reconstruction

28. Femoral head reduction osteotomy (FHRO) technique ( Coxa magna )

30. Femoral head reduction osteotomy

31. Femoral head reduction osteotomy

32. periactabularosteotomy

33. Thank you