What are the Containment Treatments Options?
In a normal hip joint the femur head usually sits about two-thirds inside the pelvic hip socket. The disintegration stage of Perthes Disease
affects this positioning as the femur head flattens. As the head flattens it can start to slip outside of the socket. This is where Containment Treatments come in.
The Five Containment Treatments
There are four common varieties of Containment Treatments available and one rarer treatment. They are:
- (external) Abduction Bracing
- Femoral Varus Osteotomy surgery
- Pelvic Osteotomy surgery
- Shelf Augmentation surgery
- Combination Pelvic and Femoral surgery
All of the surgical procedures for Containment Treatment require the hip to have a good mobility for best results.
Scottish Rite abduction brace.
Photo from Morthopedics
This is the only non-surgical option in the Containment Treatments available for Perthes Disease and is usually used in children between 6-8 years of age. There are various types of braces used for this but one of the more common ones is the Scottish Rite abduction brace which has two thigh cuffs and a bar between the knees locking the legs into position. Another version has the two thigh cuffs linked by a pelvic band to hold the legs in place which is more flexible than the Scottish rite option. Braces must be worn for 20 hours a day until the femur head has regrown.
Femoral Varus Osteotomy surgery
This surgery involves cutting a wedge shape off the top of the femur head in a way that the head cannot come out of the socket. Unfortunately to do this the part of the femur head that is not usually in the socket is now contained in the socket. This changes the way the muscles are attached to the hip and leg and can cause a limp known as the Trendelenburg limp and an uneven leg length that may require surgery later to correct both.
Pelvic Osteotomy surgery
This surgery involves cutting the pelvic bone in a way to provide more coverage over the femur head and provide better containment. It is a difficult surgery with a high potential for blood loss if not performed by an experienced surgeon. One benefit to this surgery however is that it adds length to the femur bone rather than removing length like the Femoral Varus Osteotomy surgery does.
Various versions of Pelvic Osteotomy surgeries
Shelf Augmentation surgery
This surgery involves adding a piece of bone to the hip and femur head in a way that keeps the femur head covered and allows for evenly distributed weight. It is generally done through a small precision and uses a bone graft to connect the shelf piece. The downside to this surgery is that the bone shelf and the hip that it connects to turns to fibrocartilage which doesn’t last and can bring on arthritis early in life.
Combination Pelvic and Femoral surgery
This is a big surgery combining the Pelvic Osteotomy surgery and the Femoral Varus Osteotomy surgery. It is rarely done due to the high potential for blood loss and morbidity rate.