Arthrodiastasis and surgical containment in severe late-onset Perthes disease : An analysis of 14 patients


Published online: Jun 27 2010

Pebam Sudesh, Kamal Bali, Aditya Krishna Mootha, Mandeep Singh Dhillon, Raghav Saini

From the Post Graduate Institute Of Medical Education And Research, Chandigarh, India

Abstract

late-onset Perthes disease usually carries a poor prognosis. In severe cases there may be increasing pain, decreased range of motion and hinge abduction which forms a contraindication for surgical containment. We have managed 14 such patients in a two-stage procedure. Arthrodiastasis done as a first stage dramatically reduced pain and Trendelenburg limp while at the same time leading to a substantial improvement in range of motion and hinged abduction. Once the contraindications to surgical containment were overcome by arthrodiastasis, we proceeded with a varus osteotomy of the femur in a second stage in the hope that the femoral head would remodel to some extent with time and would improve the final functional outcome.