Tripleosteotomie bei Morbus Perthes

OBJECTIVE: Osteotomy of iliac–pubic and ischial bone in order to cover the lateralized femoral head with the acetabulum. With the restoration of the containment of the hip joint, the acetabulum functions as a template for the femoral head, thus, allowing it to keep its sphericity during the vulnerable stages of Legg–Calve–Perthes disease. INDICATIONS: Lateralized femoral head in severe Legg–Calve–Perthes disease and visible head at risk signs on the radiographs. Prerequisite is possible concentric reduction of the femoral head (confirmed by preoperative abduction radiograph or arthrography). CONTRAINDICATIONS: Hinged abduction. Impossible concentric reduction of the femoral head. SURGICAL TECHNIQUE: Hip arthrography to confirm the indication of the triple pelvic osteotomy is recommended. Osteotomy of the ischial bone by a modified Ludloff approach. Osteotomy of pubic and iliac bone by anterior approach (Smith Peterson/bikini incision). Turning the acetabulum over the femoral head allows improvement of the containment of the hip. Fixation of the acetabulum with fully threaded Kirschner wires or 3.5 mm cortical screws. POSTOPERATIVE MANAGEMENT: Touch-down weight bearing with crutches (wheelchair in younger children) for 4–6 weeks depending on the age of the child. After radiologic evidence of consolidation, transition to full-weight bearing within 1–2 weeks. RESULTS: Promising results in our own practice. Good functional and radiological results in a to-date unpublished study of 30 patients with Legg–Calve–Perthes disease after an average 5‑year follow-up.