Frequently Asked Questions

How long will this last?  Generally around 3-5 years from the first stage to 'Perthes healed'.  However, it will vary with every child and can take longer.

What options are there treatment-wise?  This will depend upon the child's age, % of involvement and what your specialist is trained to do.  The younger  child (generally under 6 years) is more likely to 'wait and see' - this will involve (usually) 3 monthly visits to the specialist, usually involving x-rays and checking of ROM.  If your child is over 7 years of age, you are more likely to have more active management of perthes - depending of course, on the severity.  This could include traction, an arthrogram and petrie casts, a femoral or pelvic osteotomy or an external fixator. 

So many x-rays - is this necessary?  Unfortunately, yes!  Your specialist needs to see what is happening to the femoral head - how much damage is being done, whether or not the femoral head is contained in the socket (acetabulum).  Remind the radiographer to use a shield everytime too.

Why the restrictions?  This is to reduce the inflammation in the hip joint, which increases the amount of pain that your child has.  It will not do much to stop the damage that Perthes is doing, as this will continue to happen regardless.  Please try to adhere as closely as you can to these restrictions, particularly avoiding activities such as jumping on trampolines.  Your specialist may also ask that your child use crutches or a wheelchair to minimise weightbearing.

Is there a set treatment plan that will help?  Every case of Perthes is as unique as the child.  Your specialist should be able to predict the course it will take to a certain extent based on the age of the child, % of involvement etc.  Each treatment plan therefore needs to be tailored specifically to the child, based on what your specialist is trained to do and what is right for your family.

I've been told that a diagnosis before the age of 6 years, means no or little chance of surgery.  Why is this?  It is generally accepted that a child under 6 years of age, will have a better outcome and so the treatment plan is usually 'wait and see', as there is so much time available before they finish growing.  However, girls mature faster than boys, so that age should possibly be adjusted to 5 years for any girl.  Also, a lot will depend on the child's bone age, which is checked by xray.  Again, generally Perthes kids have a bone age that is younger than their chronological age, but not always.

Is there anything I can do to minimise the chances of surgery?  Get your child swimming!  Its the very best exercise for your child whether they are just playing in the water, actively swimming or going to organised hydrotherapy.  Best part is that we have many opportunities here in New Zealand to swim, with wonderful beaches and lakes, so swimming skills are essential and it's fun!

Is surgery required for younger children (under 6 years)?  It can be and it will be based on whether or not the femoral head is contained and whether or not ROM (range of movement) is reducing.   However, at least 80% of children diagnosed with Perthes won't need any surgical intervention at all, as their body will repair the damage over time.

Is surgery required for every child over 6 years?  No.  Decisions for surgery will be made on the same criteria as above, as well as what the family feels is right for them.

So I can decide not to go through with surgery?  Absolutely.  But, please be sure that you understand completely why your specialist is recommending the surgery and what the predicted outcomes would be with, or without surgery.  Then you will be making an informed decision.  If you are not happy, then get another opinion.  If you get a consensus from a couple of specialists that surgery is needed, then you will need to re-consider this, as this will mean that surgery will offer your child the very best outcome.

Why do older children need more active care?  Once your child finishes growing (mid to late teens), that's it, no more repairing of the damage from Perthes and/or surgery.  Your specialist will possibly mention that there are certain 'windows' of time where certain procedures will have maximum effect and that outside of these, it's probably not worth considering. 

What is the best piece of advice you can give?  Educate yourself about this.  Learn the terminology, so that when you meet with your specialist, you don't waste valuable time getting him/her to explain everything to you.  Knowledge is power and you need to make informed decisions every step of the way!