1. Legg-Perthes disease in a Down syndrome patient Jong Sup Shim Samsung Medical Canter Sungkyunkwan University School of Medicine

2. An 11 year-old female patient Painful limping for 2 months Can’t walk without assistance Has underlying Down syndrome (Diagnosed at age 11 mo) LCP disease in Down syndrome

3. Past Medical History She was diagnosed as Legg-Perthes disease at other university hospital. Operation was performed for LCP disease and hip subluxation by open reduction, varization, Salter operation and trochanteric apophysiodesis (at age 10yr 8 mo). After 2 months of Spica cast immobilization, then persistent hip dislocation was found. LCP disease in Down syndrome

4. Preop -Xray LCP disease in Down syndrome

7. Postop Postop 2 mo

8. Postop 4 mo LCP disease in Down syndrome

10. What can we do for this girl? LCP disease in Down syndrome

11. Re-Do open reduction (with tight capsular plication) Chiari osteotomy Postop cast immobilization for 6 weeks

12. LCP disease in Down syndrome Postop 3 mo

13. LCP disease in Down syndrome Left genu valgum was detected

14. Hemiepiphyseal stapling (at age 11 yr 6 mo) Preop Postop 2 yr LCP disease in Down syndrome

15. Postop 1 yr Postop 2 yr

16. Postop 1 yr LCP disease in Down syndrome

17. Postop 2 yr

18. LCP disease in Down syndrome Postop 2yr

19. Hip Joint in Down syndrome Shaw ED, Beals RK, CORR,1992 LCP disease in Down syndrome 218 hips in 114 patients with Down syndrome (10- 43 years old) 11 hips(4.8%) in 9 Patients(7.9%) had some hip abnormality Dysplasia (5) Dislocation (4) Avascular necrosis (1) – 15 yr old male Slipped capital femoral epiphysis (1)

20. Hip Joint in Down syndrome Shaw ED, Beals RK, CORR,1992 LCP disease in Down syndrome 218 hips in 114 patients with Down syndrome (10- 43 years old) 11 hips(4.8%) in 9 Patients(7.9%) had some hip abnormality Dysplasia (5) Dislocation (4) Avascular necrosis (1) – 15 yr old male Slipped capital femoral epiphysis (1)

21. Perthes disease/avascular necrosis in Down syndrome LCP disease in Down syndrome Lawhon et al, Contemp Orthop,1990 4/162 Makley and Sligar, Orthop Tran,1979 3/100

22. Treatment of severe late onset Perthes disease with soft tissue release and articulated hip distraction: early result Segev et al,JPO(B),2004 “In Down syndrome, results significantly inferior to those having only Perthes’ disease.” LCP disease in Down syndrome

23. Thank you for your kind attention