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Abstract
Treatment of Perthes’ disease is divided into: 1. Patients needing no definite treatment but only strict regular supervision by the surgeon what is called treatment by (supervised neglect). These cases are: a. Group I cases. b. Patient under 5 years of group II and group III not at risk. c. Patients between 5-7 years of group II and III not at risk. d. Cases in which healing is established. e. Cases in which serious head changes occurs. 2. Patients on actual need of definitive treatment these cases are: a. All cases with at risk signs. b. Cases of group II and III over 7 years not at risk. c. Group IV when femoral head shape changes not occurred. Management of Perthes’ disease divided into: - Observation. Intermittent symptomatic treatment. - Definitive early treatment (to prevent deformity). - Late surgical treatment (to correct existing deformity). - Late surgical treatment (for secondary degenerative osteoarthritis). Surgical methods of containment: The selection of surgical method of containment is based on the philosophy and technical experity of the individual Orthopaedic surgeon. Surgical methods of treatment are either by covering the femoral head from above by innominate osteotomy or from below by means of femoral varus derotation osteotomy which places the head deeply within the acetabulum or both or by reconstructing the acetabulum by Chiari pelvic osteotomy. The presence of significant degenerative osteoarthritis is invariably encountered in adults and usually managed by arthrodesis or prosthetic replacement, depending on the age of the patient. Future Developments: Long-term series of patients with uniform treatment who are matched for age, gender, degree of epiphyseal involvement, and other diagnostic factors, compared with an untreated control group, will no doubt be required to determine the most effective treatment Legg Calvé Perthes’ disease. As fundamental understanding of Legg Calvé Perthes’ disease increases, so does understanding of how various treatment modalities influence this complex growth disturbance.. legg calve perthes disease is a self limiting condition of the hip that leads to variable degrees of deformity and restrcted motion of the joint.the clinical presentation is usually a limp with or without pain.