Treatment of Perthes Disease

No one knows for sure what the best treatment for the disease is and there is a lot of variation in what is recommended both nationally and internationally.

All hip surgeons believe that key to a successful outcome is to maintain as much movement in the hip as possible, whilst decreasing the forces through the hip, particularly during the collapse stage of the disease. When the head of the femur is soft and needs to harden or heal, it is comparable to a jelly, and to mould this jelly to as round a shape as possible, it needs to be moving in the centre of the socket, which is the perfect mould. It is recommended therefore that children avoid jumping type activities as well as contact type sports for the duration of the disease. Non weight bearing sports such as swimming and cycling are generally good to do.

Occasionally despite everyone’s best efforts the hip can get stiff and abduction of the hip (sideways movement from the body) can be reduced. It is then essential to try and restore this as early as possible. This is where surgery can be effective.

The type of hip surgery can range from minimal, where the child is examined under anaesthetic with some dye put into the hip to assess the true shape, to osteotomy, where the femur bone is cut below the head to tilt the head into the joint for it to repair (fig 4 and 5). Often also the surgeon may decide to use plasters to try and stretch the hip for a period of time (fig 6).

The type and extent of hip surgery is variable in my practice and is tailor made to the individual’s disease and prognostic factors. Obviously this requires detailed consultation with the child and parents as everyone is different. In my experience, I am finding that early surgery, particularly with the older child, is giving better results than conservative therapy. This is an area of ongoing research in my department.

Fig 6 Abduction plasters to stretch a stiff hip