Osteochondritis dissecans following Perthes' disease. Arthroscopic-operative treatment

Osteochondritis dissecans is seen after skeletal maturity is reached in approximately 3% of adults who have had Legg-Calvé-Perthes disease as children. This diagnosis should be considered in the patient with hip pain, locking or catching, or early degenerative joint disease. In a series of 465 patients treated for Perthes' disease, 14 later developed osteochondritis dissecans. In asymptomatic hips, no treatment is indicated. In symptomatic patients, arthroscopic surgery of the hip has been employed to remove the loose osteocartilaginous fragment and to diagnose degenerative joint disease. Although removal of the osteocartilaginous fragment may not be indicated in patients with severe degenerative arthritis, an osteotomy to redirect the femoral head (valgus extension osteotomy) may be beneficial.