1 / 33

Surgical Treatment for Perthes Disease

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

connie
Download Presentation

Surgical Treatment for Perthes Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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

  8. Proximal femoral varusosteotomy

  9. Proximal femoral valgusosteotomy

  10. Valgusosteotomy

  11. Triple pelvic osteotomy

  12. Triple ost.

  13. Double-level osteotomy

  14. Shelf acetabuloplasty

  15. Chiariosteotomy

  16. Greater trochanteric advancement

  17. Biomechanical effect of coxabreva

  18. Coxabreva

  19. Neck lengthening

  20. Morscherosteotomy

  21. Morscherosteotomy

  22. biomechanical effects of the surgical reconstruction

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

  24. Femoral head reduction osteotomy

  25. Femoral head reduction osteotomy

  26. periactabularosteotomy

  27. Thank you

More Related