Surgical technique: Arthroscopic treatment of perthes disease

Abstract

Legg-Calve-Perthes disease (LCPD) is an idiopathic hip disorder that causes ischemic necrosis of the growing femoral head. It is a known cause of femoroacetabular impingement (FAI) in older children and adolescents because of the development of a misshapen head and corresponding acetabular deformity. Moreover, hip instability, extra-articular impingement, hinge abduction, and versional deformities are found in Perthes hips. These all have the potential to lead to debilitating arthritis later in life. Although hip arthroscopy has proven to be successful in the treatment of FAI, its role and indications in LCPD-associated FAI remain unclear. Historically, the most common indication for hip arthroscopy in the pediatric and adolescent population has been in LCPD, for both the diagnosis of the severity of the disease and the removal of loose bodies. With improved techniques and instrumentation, however, the indications have expanded to include femoral head/neck reshaping, labral repair, and acetabular trimming. Short-term outcomes studies have been promising; however, longer-term studies are needed to see if the natural long-term history of LCPD can be affected.