What is a triple pelvic osteotomy? This is the operation our grandson is having on his hip for a bad case of Perthes disease. It sounds really long and involved. Isn’t there something simple that can be done for this problem?

Perthes disease is a condition that affects the hip in children between the ages of four and eight. The condition three names to honor the three physicians who each separately described the disease.

In this condition, the blood supply to the growth center of the hip (the capital femoral epiphysis) is disturbed, causing the bone in this area to die.
The blood supply eventually returns, and the bone heals. In the process, the joint cartilage softens, the round head of the femur flattens, and subluxation (head of the femur shifts out from inside the hip socket) occurs.

How the bone heals determines how much problem the condition will cause in later life. This condition can lead to premature hip arthritis. That’s why every effort is made to contain (hold) the hip in the socket during the necrosis and revascularization phases. Necrosis refers to the period when loss of blood to the bone results in the death of bone cells. Revascularization is the restoration of normal blood supply.

There are different ways to contain the femoral head. Two of the better known (and most often used) methods are called femoral varus osteotomy and Salter innominate osteotomy. A triple pelvic osteotomy uses the bones on three sides of the femoral head (pubic bone, iliac bone, ischium) to hold the head of the humerus firmly in place. The surgeon uses tools and instruments to cut the bone in the pelvis, shift the pieces of bone, and reshape the bones to form a holding container around the femoral head.

This “container” approach is used with severe cases of Perthes disease. In such cases, holding the femoral head in place is required for a longer period of time than is possible with cast immobilization. Using one of the other two more traditional osteotomy procedures isn’t enough either.

The surgeon uses X-rays and other more advanced imaging studies to examine the anatomy of the hip when planning the most appropriate (and hopefully most effective) procedure. Studies show that even in older children whose bones are less likely to reshape easily do respond well to the triple pelvic osteotomy.