Perthes Disease Treatment

What is VDRO?

A femoral osteotomy procedure that repositions the femoral head deeper into the acetabulum (hip socket) by cutting the femur and realigning it in a varus (inward) position with derotation.

Indications

• Children older than 6-8 years with poor femoral head containment
• Lateral pillar B or C classification
• More than 50% femoral head involvement
• Hinged abduction on clinical examination

Timing

Best performed during fragmentation or early reossification stage. Should be done when hip still has adequate range of motion.

Benefits

• Improves femoral head coverage
• Reduces hinge abduction and impingement
• Better long-term hip shape and function

Recovery

6-8 weeks non-weight bearing with crutches, followed by gradual weight bearing. Full recovery typically takes 4-6 months. Hardware removal may be needed after 12-18 months.

What is Shelf Procedure?

A pelvic osteotomy that creates a bony shelf over the femoral head to improve lateral coverage. The ilium is cut and displaced medially to create additional coverage for the femoral head.

Indications

• Older children (>8 years) with inadequate lateral coverage
• Severe femoral head deformity or asphericity
• Late presentation in fragmentation or reossification stage
• When femoral osteotomy is not suitable

Timing

Can be performed in fragmentation or reossification stage. Often used as salvage procedure in late-presenting cases or when other surgeries have failed.

Benefits

• Provides lateral support and coverage
• Reduces joint pressure and prevents further deformity
• Can be used even with severe deformity

Recovery

6-8 weeks protected weight bearing, followed by gradual return to activities. Full recovery takes 3-6 months. Long-term outcomes depend on severity of initial deformity.

What is Salter Osteotomy?

A pelvic osteotomy that redirects the acetabulum by cutting through the innominate bone above the acetabulum and rotating it forward and downward to improve anterior and lateral coverage.

Indications

• Younger children (4-8 years) with inadequate acetabular coverage
• Good hip range of motion and spherical femoral head
• Early to mid-fragmentation stage
• Lateral pillar B classification

Timing

Best performed early in the disease process during fragmentation stage when femoral head is still relatively spherical. Earlier intervention generally gives better results.

Benefits

• Improves anterior and lateral acetabular coverage
• Maintains hip joint congruency
• Single bone cut with good stability
• Predictable outcomes in appropriate candidates

Recovery

4-6 weeks non-weight bearing, then gradual progression to full weight bearing. Physical therapy for hip range of motion. Full activity typically resumed after 3-4 months.

What is Triple Osteotomy?

An advanced pelvic osteotomy involving three bone cuts (pubis, ischium, and ilium) allowing complete reorientation of the acetabulum for maximum correction of coverage deficiency.

Indications

• Older children and adolescents (>10 years) with severe coverage problems
• Severe acetabular dysplasia requiring major correction
• Late stage disease with healed but deformed femoral head
• When simpler procedures are inadequate

Timing

Usually performed in late reossification or healed stage. Reserved for cases where maximum acetabular reorientation is needed. Often done as salvage procedure.

Benefits

• Maximum degree of acetabular reorientation possible
• Can address severe multidirectional coverage deficiency
• Preserves joint anatomy without entering joint

Recovery

8-12 weeks protected weight bearing due to multiple osteotomies. Intensive physical therapy required. Full recovery may take 6-9 months. More complex than single osteotomy procedures.

What is Combined Osteotomy?

Simultaneous or staged femoral (VDRO) and pelvic osteotomy (Salter or shelf) to address severe deformity and coverage problems from both femoral and acetabular sides.

Indications

• Severe Perthes disease with both femoral head deformity and acetabular insufficiency
• Lateral pillar C classification in older children
• Hinged abduction with acetabular dysplasia
• When single procedure would be insufficient

Timing

Can be done simultaneously or staged (femoral first, then pelvic 3-6 months later). Decision depends on surgeon preference, patient age, and severity of deformity.

Benefits

• Addresses both femoral and acetabular pathology
• Maximum improvement in hip biomechanics and coverage
• Better long-term outcomes in severe cases

Recovery

More prolonged recovery than single procedures. 8-12 weeks protected weight bearing. Extensive physical therapy needed. Full recovery 6-12 months. If staged, total treatment extends over 12-18 months.

Soft Tissue Release

Release of tight hip adductors and iliopsoas to improve hip range of motion before or after osteotomy. Indicated when severe stiffness limits hip abduction.

Arthroscopic Debridement

Minimally invasive removal of loose bodies, damaged cartilage, or osteophytes causing mechanical symptoms or impingement. Used in late stage for symptomatic relief.

Femoral Head Reduction (Cheilectomy)

Removal of bony overgrowth or prominence from femoral head to reduce impingement. Indicated when femoral head asphericity causes painful mechanical symptoms despite healing.

Hip Arthrodesis (Fusion)

Rarely used salvage procedure fusing hip joint in cases of severe joint destruction with intractable pain unresponsive to other treatments. Reserved for extreme cases only.

Hip Replacement (in Adulthood)

Total hip arthroplasty may eventually be needed in adulthood if severe deformity leads to early arthritis. Modern implants and techniques provide good outcomes even in young adults with Perthes sequelae.