Containment surgery for Perthes disease involves osteotomy (bone-cutting) of the femur or pelvis to keep the softened femoral head contained within the acetabulum during the healing phase, maintaining a spherical shape as the bone regenerates.
The most common procedures are femoral varus osteotomy (cutting the thighbone and angling it inward to deepen the femoral head within the socket) or Salter innominate osteotomy (redirecting the socket to cover the femoral head better). The osteotomy is fixed with a plate and screws. The operation takes one and a half to two hours.
Surgery is considered for children over six to eight years with significant femoral head involvement (lateral pillar classification B or B/C) where non-operative containment (bracing, activity modification) is insufficient. The aim is to maintain femoral head sphericity during the revascularisation phase.
Activity modification, physiotherapy (range of motion exercises), anti-inflammatory medication, and observation. Many children with Perthes disease, particularly those under six, do well without surgery.
Serial X-rays and MRI to assess disease stage. Arthrogram may be used intra-operatively.
Maintenance of a spherical femoral head, which is the key determinant of long-term hip function. Children treated with appropriate containment have better outcomes than those with uncovered, deformed femoral heads.
Particularly with femoral osteotomy. Usually mild and manageable.
Temporary during recovery.
Plates and screws are palpable.
Excessive varus may cause trochanteric prominence.
Hip stiffness. Early physiotherapy is important.
The osteotomy may fail to heal. Rare in children.
Wound or deep infection.
Despite containment, some deformity may persist.
General anaesthesia.
Crutches or wheelchair for six to eight weeks. Physiotherapy for hip range of motion. Return to normal activity at three to four months. Metalwork removal at twelve to eighteen months. Long-term X-ray follow-up.
Regular X-rays every three to six months until femoral head regeneration is complete (typically two to four years).
Perthes disease occurs when the blood supply to the femoral head is temporarily disrupted, causing the bone to soften and potentially deform. It affects children between four and ten years of age and is self-limiting — the bone eventually revascularises and regenerates.
Not all children with Perthes disease need surgery. Children under six often do well without intervention. Surgery is considered for older children with significant femoral head involvement.