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Role of Femoral Head Surgery in Skeletally Mature Perthes Disease

Sucato, Daniel J. MD, MS

Journal of Pediatric Orthopaedics: July/August 2013 - Volume 33 - Issue - p S70–S75
doi: 10.1097/BPO.0b013e318295e86b
Hip Disorders Supplement

Legg-Calve-Perthes disease (LCPD) nearly always results in femoral deformity at skeletal maturity that may lead to symptoms due principally to femoroacetabular impingement. Treatment for the skeletally mature patient with LCPD varies from observation with activity modifications to surgical procedures which range from isolated femoral or acetabular-sided surgery to the more common combined surgery. On the femoral side, the traditional procedures have been proximal varus and valgus osteotomies (with some component of flexion) to reorient the femoral head and allow better femoral head weight-bearing cartilage across the hip joint. Acetabular procedures have been used less frequently including reorientation or shelf procedures to provide improved femoral head coverage. The challenge in the skeletally mature hip patient is to determine which of these components require addressing at the time of surgical treatment. More recently, procedures to the femoral head itself have been developed to reshape the femoral head and assist in matching the size of the femoral head to the acetabulum, prevent impingement and restore more normal articular cartilage in the weightbearing zone. This review will focus on these surgical treatments specific to the femoral head in skeletally mature LCPD.

Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX

The author did not receive financial support for this study.

The author declares no conflict of interest.

Reprints: Daniel J. Sucato, MD, MS, Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn St., Dallas, TX 75219. E-mail:

© 2013 by Lippincott Williams & Wilkins