Containment osteotomies for Perthes disease: indications, postoperative course and prognosis. Dr. Priano, Milan.
Containment procedures when necessary
Learn about this condition →Procedure reorienting femoral head within acetabulum to improve coverage and promote spherical remodeling during healing phase.
Perthes with compromised head sphericity, lateral subluxation, children over 6-8 years with unfavorable prognosis.
Postoperative immobilization and non-weight bearing for 6-8 weeks. Prolonged physical therapy. Results evaluable after years.
Pelvic procedure reorienting acetabulum to improve femoral head coverage.
Indicated alone when femoral head maintains good sphericity but presents lateral subluxation or insufficient acetabular coverage. May be combined with femoral osteotomy in more complex cases.
Variable postoperative immobilization. Prolonged rehabilitation. Results evaluable years later.
Perthes disease has a natural course of 2-4 years. Not all cases require surgery. Decision based on specific prognostic factors (age, necrosis extent, head sphericity). The timeline below is a general baseline that varies depending on the surgical technique chosen (femoral vs pelvic vs combined osteotomy).
Note: This is an indicative pathway, personalised after surgery. Some elements are relatively stable (goal of the procedure, approximate hospital stay, presence of a cast or brace); others depend on the individual case (weight bearing, range of motion, imaging, sport, hardware removal, follow-up intervals) and on the surgical technique chosen.
3-5 days hospitalization. Surgery under general anesthesia.
Weeks 1-6: Immobilization in spica or brace. Crutches non-weight bearing. Bed physical therapy to prevent stiffness.
Months 2-3: Cast/brace removal. Start progressive partial weight bearing. Aquatic therapy very helpful.
Months 3-6: Progressive weight bearing. Swimming and cycling. Avoid impacts and jumping. X-ray checks.
Disease lasts 2-4 years regardless of surgery. Impact sports discouraged throughout active phase. Swimming and cycling allowed.
Checks every 3-4 months during active disease phase. Then biannual until end of growth. Hardware removal after 1-2 years.
Residual femoral head deformity (coxa plana, coxa magna): may lead to early arthritis. Limb length discrepancy. Joint limitation.
Causes, diagnosis, conservative options and when surgery is considered.
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