Treatment by Age

Since bone healing and regrowth potentials change with age, children that develop Perthes at a certain age should receive treatment appropriate to their age group and treatments on this site are described based on the age of the child. For example, younger children have more healing potential and more time to regrow their bone than older kids and may need less aggressive theatment.  Additionally, children with less area of the femoral head affected by the loss of blood flow have less diseased bone to heal than kids with more severe cases. Following are our current consensus on treatment by age.  More detailed information is provided in each age group section below.  There may be instances for each age group where a treatment more commonly used in other age groups may be recommended.  

Age less than 6 at onset
: treat symptoms (pain, limping, and decrease in hip joint movement) by nonsurgical means like rest, limiting running and jumping activities, anti-inflammatory medicine and crutches/ walker/wheelchair as needed)  

Age 6-8 at onset
: non-operative treatments (similar to less than 6 year old patient and brace)  or operative treatments (femoral or pelvic bone surgery) can be used but we do not know which is better at this time.  This is why IPSG is study the outcomes of patients treated non-operatively and operatively in this age group (see "Current Studies")

Age 8-11 at onset: operative treatment is recommended in severe cases (i.e. most of the femoral head is affected by Perthes).  Conventional surgical treatments include femoral bone or pelvic bone surgery)

Age over 11 at onset
: conventional femoral or pelvic bone surgeries are not as effective in this age group compare to the younger patients.  Newer treatments such as multiple drilling of femoral head to create channels for blood vessels to grow back and hip distraction using an external fixatior to protect the femoral head are being done in some centers.  IPSG will be comparing the results of these newer procedures.