Under Age 6
Most children who are diagnosed with Perthes disease before the age of 6 have a favorable long term outcome regardless of the treatment [Reference]. Most doctors recommend some activity restrictions, avoiding impact activities like running and jumping, while still allowing biking and swimming. Sometimes physical therapy is recommended to help with stretching and to minimize muscle weakness. Anti-inflammatory drugs may be used occasionally to help decrease pain in the hip. However, daily use of an anti-inflammatory drug may hinder bone formation. Wheelchairs and temporary bed rest may also be used to rest the hip.
In hips that are very stiff or have more serious involvement, surgery may be recommended. Often it involves injecting dye into the hip (also known as hip arthrography) and then moving the hip while looking at it with an x-ray machine when the kids are under anesthesia. Cutting of a tight tendon in the groin, also known as a tenotomy, followed by placing two casts (also known as Petrie casts) with a bar between them in the shape of an “A” as shown below helps to increase hip joint mobility and decrease inflammation. In rare cases, cutting the bones to reposition the hip is utilized.