Core Decompression and Labral Support for the Treatment of Juvenile Osteonecrosis

The final outcome of Legg-Calvé-Perthes disease is variable and depends mostly on the age of the patient at onset and the amount of femoral head involvement. The goals of treatment are to achieve a round femoral head with a congruous hip joint and to contain the femoral head to avoid extrusion. We will term this condition in the adolescent age, "juvenile osteonecrosis," as we understand that the osteonecrosis pattern responds differently to that in younger patients who develop Perthes and it is similar to adult osteonecrosis. Most of the deformity comes from the collapse and enlargement in size of the femoral head. Therefore, the treatment rationale should be tailored to address these differences. We believe that early core decompression combined with containment in the form of a shelf acetabuloplasty can change the natural history of the disease based on both adolescent and adult literature. The core allows removal of the necrotic segment; it improves vascularization to the affected area and may provide structural support in some cases. The shelf provides support to distribute the forces across the joint and prevents lateral migration. It also provides better acetabular roof to prevent early dysplastic changes that lead to arthritis.