Choosing a Treatment Course

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It is not uncommon to receive multiple options and opinions regarding treatment of Perthes for your child. This will be even more so the case if you consult multiple physicians. It does not imply that one option or opinion is more correct than the others. To help you make the best decision for your child, we have summarized and broken down what most orthopedic surgeons agree on and also what is considered controversial and up for debate.

What do most orthopedic surgeons agree on?

  • Range-of-motion (ROM) is good for the hip.
  • The long-term prognosis is worse with increasing age.
  • Children under the age of 6 rarely require treatment.
  • Partial head involvement does not require treatment.
  • Whole head involvement in children over age 6 has a better prognosis with any type of treatment than with no treatment.
  • There is no evidence that one method of Containment is better than any other method.

What is controversial?

  • The best method for containment—femoral osteotomy vs. pelvic osteotomy vs. brace vs. shelf.
  • Core decompression is unproven. Should it be used in early cases or is the risk of premature growth arrest too high?
  • Is distraction better than containment? Is it the best treatment option for older children?
  • Should children over age 10 not receive treatment since the results of containment treatment at that age are poor?

How do I reconcile these controversies for my child?

  • The best method of containment?
    • If you can maintain ROM and tolerate the external brace for 1–2 years (less in younger children), this is a viable treatment strategy. If you cannot tolerate the brace, review the pros and cons of containment treatment and see what you feel most comfortable with. Discuss with your surgeon. Discuss with your child.
  • Is core decompression the best strategy for my child?
    • Review the results from Dr. Lopes. At this time, it is a low-risk procedure and if it works, you win. If it does not work, there is minimal risk.
  • Is distraction treatment the best strategy for my child?
    • Preliminary results suggest that distraction treatment is at least as good as containment methods. If planning a containment surgery, consider distraction as an alternative. For children over age 9, distraction is probably the best choice. After a failed containment treatment, distraction can salvage the hip. This method may not be available in your area, however, so you may need to travel to receive this treatment.
  • Should I not treat my child if they are over 10 years old?
    • This is probably true for containment methods. Not true for distraction. There is nothing to lose with distraction treatment. A failed distraction is no worse than no treatment.

We hope this helps to clarify some of the issues and controversies surrounding the treatment of Perthes disease. We recommend that you continue to learn all that you can about this disease and consider the various factors as you face an important and difficult decision for your child. Obtain different opinions. Speak with other Perthes parents about their experience. This can help guide your process.