This document discusses osteonecrosis (avascular necrosis), specifically of the hip, and Perthes' disease. It covers anatomy, causes, pathogenesis, pathology, imaging, staging, and various management approaches. For osteonecrosis of the hip, management may include core decompression, unloading osteotomy, or arthroplasty. For Perthes' disease, which causes avascular necrosis of the femoral head, treatment depends on the stage, age, and bone age of the patient and may include symptomatic treatment, abduction bracing, or operative containment such as osteotomies. The goal of treatment is to contain the femoral head within the acetabulum to allow healing.

1. Osteonecrosis
Avascular Necrosis of Hip
&
Perthe’s Disease

2. Anatomy

3. Applied Anatomy

4. Causes

5. Pathogenesis

6. Pathology

7. Imaging

8. Sites..

9. Staging

10. Management

13. OSTEOCHONDROSIS
(OSTEOCHONDRITIS)

14. AVN Hip

17. Retinacular Vessels

18. Clinical Features
• Pain
• Movement restriction
– Abduction
– Internal Rotation

19. X-Ray

20. Post Traumatic

21. MRI

22. Osteo Arthritis

23. STAGING

24. Core Decompression

25. Unloading Osteotomy

26. Arthroplasty

27. PERTHES’ DISEASE
• Perthes’ disease – or rather Legg–
Calvé–Perthes disease.
• 1910-the condition was described
independently by three different
people
• is a painful disorder of childhood
characterized by avascular
necrosis of the femoral head

29. Clinical Features
• Pain
• Movement restriction
– Abduction
– Internal Rotation
• Limp

31. Herring’s Lateral Pillar Classification

32. Catterall’s Classification

33. Head at Risk Signs

34. GUIDELINES TO TREATMENT
• based on an assessment of
– the stage of the disease,
– the prognostic x-ray classifications,
– the age of the patient
– The clinical features, particularly range of
abduction and extension.

35. Children under 6 years
• No specific form of treatment has much
influence on the outcome.
• Symptomatic treatment, including activity
modification, is appropriate.

36. Children aged 6–8 years
• In this group the bone age is more important
than the chronological age

37. Bone age at or below 6 years
• Lateral pillar group A and B (or Catterall stage I
and II)
– symptomatic treatment.
• Lateral pillar group C (or Catterall stage III and
IV)
– abduction brace.

38. Bone age over 6 years
• Lateral pillar group A and B (Catterall stage I
and II)
– abduction brace or osteotomy.
• Lateral pillar group C (Catterall stage III and IV)
–outcome probably unaffected by treatment,
but some would operate.

39. Children 9 years and older
• Except in very mild cases (which is rare), operative
containment is the treatment of choice.

40. Aim of Treatment

42. Abduction Splint

43. Innominate osteotomy

44. Femoral Osteotomy

45. Innominate Osteotomy

46. Combined