Surgery: Perthes Disease
Containment osteotomies for Perthes disease: indications, postoperative course and prognosis. Dr. Priano, Milan.
Containment procedures when necessary
Learn about this condition →Surgical Techniques
Femoral Varus Osteotomy
Procedure reorienting femoral head within acetabulum to improve coverage and promote spherical remodeling during healing phase.
Indication
Perthes with compromised head sphericity, lateral subluxation, children over 6-8 years with unfavorable prognosis.
Recovery
Postoperative immobilization and non-weight bearing for 6-8 weeks. Prolonged physical therapy. Results evaluable after years.
Pelvic Osteotomy (Salter, Triple)
Pelvic procedure reorienting acetabulum to improve femoral head coverage.
Indication
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.
Recovery
Variable postoperative immobilization. Prolonged rehabilitation. Results evaluable years later.
Postoperative Overview
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).
Detailed Recovery Timeline
Note: The timeline below is a general baseline. The actual postoperative course varies depending on the specific surgical technique chosen (see procedures above).
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.
Return to Sport
Disease lasts 2-4 years regardless of surgery. Impact sports discouraged throughout active phase. Swimming and cycling allowed.
Follow-up Schedule
Checks every 3-4 months during active disease phase. Then biannual until end of growth. Hardware removal after 1-2 years.
Possible Complications
Residual femoral head deformity (coxa plana, coxa magna): may lead to early arthritis. Limb length discrepancy. Joint limitation.
Perthes Disease: condition information page
Causes, diagnosis, conservative options and when surgery is considered.
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