Age 8 and Over
Kids diagnosed with Perthes after age 8 have the most guarded long term outlook. The natural history, or what would happen if nothing is done, is generally poor unless the disease is mild. Therefore surgery is frequently recommended.
Surgical treatment involves cutting one of the bones around the hip, and is called an osteotomy. A femoral osteotomy (shown below) means the cut is in the thigh bone (also called femur) 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 promote round healing of the ball joint. Plates and screws are commonly used to hold the cut bones and casts are 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.
Some cases are so severe that simply cutting the bones does not allow the hip to be repositioned. A device outside the skin with pins connected to the thigh and socket bone can be used to help pull the bones apart and then allow them to be repositioned for the best fit. This is called a hip joint distraction with an external fixator. The external fixator may have hinges to allow some hip movement or may be solid not allowing movement. The external fixator is gradually adjusted until the hip is in the best position possible. The hip is then left in this “best fit” position for about 4 months to allow for healing. Physical therapy during the healing process and after the fixator is removed are very important. Some surgeons recommend doing the hip joint distraction surgery early to protect the ball part of the hip joint. Usual duration of hip joint distraction is about 3-4 months. Alternative options of treatment, such as multiple epiphyseal drilling or femoral head tunneling are also being tried at some centers. However, the effectiveness of hip joint distraction and multiple epiphyseal drilling is not established and is being studied by the IPSG.