surgical treatment for perthes disease
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Surgical Treatment for Perthes Disease. Mazloumi MD Associated professor Orthopaedic surgeon. A 14-year-old boy who had Legg-Calve´- Perthes disease at age 8 years and was treated with nonoperative methods. Pathomechanical environment. Structural instability - PowerPoint PPT PresentationTRANSCRIPT
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Surgical Treatment for Perthes Disease
Mazloumi MDAssociated professorOrthopaedic surgeon
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A 14-year-old boy who had Legg-Calve´-Perthes disease at age 8 years and was treated with nonoperative methods
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Pathomechanical environment
• Structural instability• Femoroacetabular impingment• Articular incongruity (localized joint overload)• Abductor inefficiency (articular overload)• Combinations
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Perthes deformitiesProximal 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
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Perthes deformities
Acetabulom ( spectrom and variabilities of deformities)
• Decreseade anterolateral and/or posterolateral femoral head coverage.
• Increased acetabular inclination.• Relative acetabular deficiency.• Variable acetabular version
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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
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Surgical approaches for treatment of sequelae of Perthes disease
Extraarticular methods Intertrochanteric valgus osteotomy 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) Noncontainment acetabular 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 osteochondritis dissecans Labral repair
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Proximal femoral varus osteotomy
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Proximal femoral valgus osteotomy
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Valgus osteotomy
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Triple pelvic osteotomy
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Triple ost.
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Double-level osteotomy
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Shelf acetabuloplasty
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Chiari osteotomy
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Greater trochanteric advancement
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Biomechanical effect of coxa breva
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Coxa breva
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Neck lengthening
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Morscher osteotomy
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Morscher osteotomy
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biomechanical effects of the surgical reconstruction
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Femoral head reduction osteotomy (FHRO) technique ( Coxa magna )
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Femoral head reduction osteotomy
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Femoral head reduction osteotomy
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periactabular osteotomy
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Thank you