الفهرس 
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Abstract
Perthes‟ disease (Legg-Calvé-Perthes‟ disease) is avascular necrosis of the capital femoral epiphysis of unknown etiology.
Late-onset Perthes‟ disease” (onset after 7 years) has aggressive course and poor outcome. Containment of the femoral head within the acetabulum is not useful in the treatment of late Perthes‟ disease because of the short time left until skeletal maturity for remodeling. Salvage procedures were used in treatment of already malformed head without effect on osteoarthritis of hips. This lead to the use of arthrodiastasis with minimal soft tissue release in the treatment of late onset Perthes disease. This method improve cartilage repair and ossification of repaired cartilage and so the shape of head and acetabulum by relieving the deforming forces and allow motion of hip joint.
Aim of the work was to evaluate the results of hip arthrodiastasis as a treatment option for patients with late-onset Perthes‟ disease using a simple frame and a limited soft tissue release. A prospective study was performed for patients with late onset Perthes‟ disease. In the period between June 2013 to June 2016, the study was conducted on 17 patients (20 hips). Three patients had both hips affected. All patients were operated upon in Menofiya university hospital. The minimum follow up of the patients was one year.
All patients were treated by arthrodiastasis with minimal soft tissue release.
All patients were evaluated clinically, radiologically ( preoperative, postoperative). Clinical evaluation according to Muller and Seddon system Radiological evaluation include superior subluxation, lateral subluxation, head spherecity, EI.
All patients had mean preoperative pain score 3 (SD: 0) and improved postoperatively to 4.68±0.48 (range , 3-5). This was statistically highly significant ( p = 0.001)
The range of motion preoperative was limited for abduction, internal rotation and external rotation only while other motion flextion (140)o, adduction (40)o are normal so there is no marked variation or severe limitation in range of motion. The mean range of motion preoperative was 263.68±13.21 (range, 235-270) o and improved to 298.68±30.76 ( range, 235-315 ) o this was statistically highly significant ( p = 0.001).
Activity mean score preoperative was 3 and it was improved post operatively to 4.7±0.67 (range, 3-5). This was statistically highly significant ( p=0.001)
Fourteen patients (14 hips) had trendlenberg gait preoperative, all of them had improved gait post-operative , one patient cannot be assessed clinically because of brain insult. Three patients (six hips) had waddling gait , two patients (four hips) improve gait . One patient persisted to have waddling gait post-operatively. This was statistically highly significant p=0.001.
As regard to superior subluxation: Mean 2.9±1.09 (range, 1-5) mm pre operative and improved to mean 0.6 ± 1.14 (range, 0-3) mm. this was statistically highly significant ( p= 0.001)
As regard to lateral subluxation: (by calculation of Reamer migration index). Reamer migration index was <30 % (no subuxation) in 17 hips pre-operative, 6 of them had RMI preoperative 0 and persisted post-operative, the remaining 11 patients improved post-operative. Mean 18.25 ± 14.54 (range, 0-53) % preoperative and postoperative mean 16.1±15.80 (range , 0 - 65) % this was statistically non-significant ( p= 0.657 ) .
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Epiphyseal index: Mean 15.2±5.90 (range , 6 – 25) % and improved post-operative to 25.1±7.85 (range , 12 to 40) % This is statistically highly significant ( p= 0.001).
There was significant inverse correlation between age and total score. There was significant inverse correlation between duration of complain and total score. There was significant inverse correlation between duration of follow up and total score.
There were minimal complications in this study which were within the accepted range. All complications were controlled except in one patient who had postoperative brain insult.