What is the treatment for Perthes' disease?
The aim of treatment is to:
- Promote the healing process; and
- To ensure that the top of the thigh bone in the hip joint (the femoral head) remains well seated in the hip socket as it heals and regrows.
Which treatment is chosen will depend on the age of your child and how badly your child's hip is affected. Treatments may include observation, bed rest and/or using crutches, wearing a plaster cast or a special leg brace, or surgery. Your doctor will advise on the best treatment for your child.
Observation and physiotherapy
In younger children (less than 6 years old) and those with mild disease, Perthes' disease will usually heal well without any specific treatment. These children are treated by observation, often with physiotherapy or home exercises. The home exercises help to keep the hip joint mobile and in a good position in the hip socket. Advice may also include:
- To encourage swimming (to keep the hip joint active in the full range of movements); but
- To avoid activities that can lead to any heavy impact on the hip joint, such as those involving trampolines and bouncy castles.
However, any advice will be tailored to your child's needs. Your child will also need regular follow-up with their specialist to check how their femoral head is healing. Regular X-rays of their hips are usually suggested.
Painkillers may also be useful to help relieve pain. Common painkillers suggested are ibuprofen and paracetamol.
Bed rest and/or crutches
This may be needed by some children for a short time if their symptoms are bad.
Will surgery be needed?
An operation may be considered in some cases, particularly in older children or those more severely affected. Surgery can help to keep the femoral head in the right position while it heals. Surgery can also be used to improve the shape and function of the femoral head if it has not healed well.
Further reading and references
Kannu P, Howard A; Perthes' disease. BMJ. 2014 Sep 23349:g5584. doi: 10.1136/bmj.g5584.
Kim HK, Herring JA; Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am. 2011 Jul42(3):285-95, v. doi: 10.1016/j.ocl.2011.04.007.
Shah H; Perthes disease: evaluation and management. Orthop Clin North Am. 2014 Jan45(1):87-97. doi: 10.1016/j.ocl.2013.08.005. Epub 2013 Sep 26.
Larson AN, Sucato DJ, Herring JA, et al; A prospective multicenter study of Legg-Calve-Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Joint Surg Am. 2012 Apr 494(7):584-92. doi: 10.2106/JBJS.J.01073.
I was diagnosed very early around 5, so I just had to wear a brace with yearly trips to the Shriners hospital for ortho checkups, the only issue is my right leg is slightly shorter and have had to...tonya79
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