Perthes

 

 

Incidence

 

Zhi et al Int Orthop 2023

- incidence of OA after Perthes

- nonoperative treatment: 23% THA at 40 years

- operative treatment: 18% THA at 40 years

 

Issues

 

Femur	Acetabulum	Leg Length Discrepancy	Abductors
Multiplanar deformity	Element dysplasia	2 - 4 cm	Shortened
Worsened by previous surgery			May need trochanteric slide
Risk of intra-operative fracture
May require osteotomy

 

Shallow acetabulum

 

Technique

 

Option

- monoblock stem

- modular stem

 

Uncemented stem

 

Modular stem

 

Trochanteric slide

 

Results

 

Hanna et al Arch Orthop Trauma Surg 2017

- 6 studies and 245 THA in Perthes

- intra-operative fracture 11% reduced with used of modular stems

- sciatic nerve palsy 3% associated LLD 1.9 cm and previous surgery

 

Baghdadi et al CORR 2013

- 99 THA for Perthes

- follow up 8 +/- 5 years

- 10% revision rate

- 9% intraoperative fracture (mostly femur)

- 3 sciatic nerve injury with lengthening of 2.2 +/- 1 cm