Developmental Hip Dysplasia Presenting as Bilateral Osteochondritis Dissecans Perthes-like Lesions Treated with Triple Pelvic Osteotomies: A Case Report.

Introduction: Osteochondritis dissecans (OCD) of the femoral head accounts for approximately 2% of all OCD cases. Most of the OCD lesions affecting the femoral head are secondary to pathologies concerning the femoral component of the hip joint, such as Legg-Calvé-Perthes (LCP) disease. Although there are reports of OCD secondary to hip dysplasia, to our knowledge, there is no report of bilateral OCD lesions being treated successfully with bilateral triple pelvic osteotomies (PAO) in a pediatric patient.

Case report: In this report, we present the case of an 8-year-old Hispanic male who presented with bilateral hip pain unresponsive to conservative treatment and initially managed with the presumptive diagnosis of LCP disease. Due to his persistent hip pain and no improvement on follow-up X-rays and magnetic resonance imaging (MRI), the patient was referred to our hip preservation clinic for further work-up and management recommendations. MRI revealed bilateral OCD lesions of the femoral head secondary to developmental hip dysplasia. The patient underwent bilateral triple PAO for correction of the patient's bilateral hip dysplasia, which resulted in the proper resolution of the femoral head lesions on imaging and eventually resolved the patient's hip pain.

Conclusion: This report aims to recognize the association between untreated developmental hip dysplasia and femoral head Perthes-like lesions in the pediatric population. Orthopedic surgeons must consider developmental hip dysplasia when determining the etiology of Perthes-like lesions in pediatric patients.