Into Adulthood

Supposedly, Perthes is a childhood condition and you are now 'Perthes healed', because you aren't a child anymore.  You have finished growing and your body has repaired as much damage as it could from Perthes (and possibly surgery).  You possibly have a leg length discrepancy (LLD), a limp or rolling gait, some pain or stiffness and the knowledge that your childhood was different from others, because of all the restrictions and other changes that were made to accomodate Perthes.  If you had surgery for Perthes, then you can add scarring to your body and minor changes in your skeletal structure too if you had an osteotomy.

What now?  If your hips were x-rayed today, there would potentially be changes apparent in the hip that Perthes attacked (or both, if you were bi-lateral), so it stands to reason that there could be problems in the future.  Your femoral head will be a different shape from the normal rounded shape seen and it may be a bit too large for the socket; your acetabulum (hip socket) will possibly be reshaped to accomodate this and it may function reasonably well, but still look different.  Your femoral neck may be widened and shortened - this will be possibly where your leg length loss is attributed to.

You have a reasonably high chance of needing a hip replacement when you are older if the damage is extensive enough.  There are now hip re-surfacings being done here in New Zealand and this may be an option for you, however finding a surgeon who can do this and feels confident that it will work is another matter.

As far as a hip replacement goes, the femur will be cut where it goes into the neck.  A prosthesis will then be surgically attached which will be the new femoral neck and head.  They can adjust how that sits so that there is no longer a difference in your leg length. 

What sort of work can you do?  This will depend on how extensive Perthes was.  If you had a mild case, then you can probably do any job you want to.  However, if you had a more severe case and also if surgery was done, then you will need to take potential limitations in your ability to stand for prolonged periods and the ease with which you can climb a ladder, or get onto the floor and back up again, into account. 

I have got pain in my hip/groin/behind my knee - what do I do?  Go to your GP.  He or she may be able to check your ROM (range of movement) and based on that either refer you to a specialist and for x-rays, or just the x-rays and see what they show before a referral is done.

 For a woman there are different concerns -

Will I be able to get pregnant?  Having had Perthes should have no effect on your ability to conceive a baby. 

Will I be able to carry a baby fullterm? This is something that will depend a lot on what condition your pelvis is in and what sort of surgery you had for Perthes, so you will possibly need to be under obstetric care for your pregnancy so that your health is assessed properly right the way through.

Do I have a higher chance of needing a caesarian section? Apparently not.  Chances are if you do end up with a C-section, then you probably would have had to have one, even if you hadn't had Perthes.  Again a specialist should be able to advise on your specific case.

I ended up with an emergency C-section and now they want to do a pelvimetry - what is it and why? The best way I can describe a pelvimetry is that you go feet-first into a CAT scan machine.  They take measurements of your pelvis and will be able to tell you what shape your pelvis is, whether or not that contributed to the C-section. 

*  I had a pelvimetry done after my first born was an emergency C-section.  I was told my pelvis was flattened and I would never deliver a child naturally.  With the support of my midwife and obstetrician, I was allowed a 'trial of labour' for my second child and she was born vaginally after 4 1/2 hours labour.  I understood that the slightest indication of distress for me or the baby and we were straight up to theatre for another C-section, but I made an informed decision that worked for us.