This age group has the largest variability in treatment options. This age group also has the greatest variability in long term outcome with some kids doing very well and others developing degenerative arthritis.
Some kids will have milder cases of Perthes that can be treated with activity restrictions, physical therapy and anti-inflammatory medication. Temporary bed rest or decreased weight bearing with a wheelchair or crutches can also be used to decrease the pressure on the hip and the hip joint irritation.
In more moderate cases with a very stiff hip, soft tissue surgery to increase hip joint mobility and casting to rest the hip are recommended. The surgery may involve injecting dye into the hip joint and then moving the hip while looking at it with an x-ray machine (called hip arthrogram). Cutting of a tight tendon in the groin, also known as a hip adductor tenotomy, followed by placing two casts (called Petrie casts) with a bar between them in the shape of an “A” helps to increase leg spreading (i.e. hip abduction) and decrease inflammation. These Petrie casts are commonly worn for 6 weeks and then followed with a brace called A-frame that keeps the legs spread apart but allows kids to walk with assistance.
Unfortunately, many kids in this age group have more severe involvement and benefit from more extensive surgery. An osteotomy involves cutting one of the bones around the hip. This allows the hip to be repositioned for optimum healing. A femoral osteotomy means the cut is in the thigh bone and a pelvic osteotomy means the cut is in the socket bone above the hip. Both surgeries are meant to put the hip in a better position to get rounder healing of the ball joint. Plates and screws are commonly used to hold the cut bones and cast may be placed to protect the surgery. Physical therapy after surgery may be used to strengthen the muscles and maintain mobility. The plates and screws are routinely removed once the hip is healed.