What's the ideal time for treatment of Legg-Calvé-Perthes Disease? Our six-year old son has this condition. We live in Europe and don't expect to return to the United States for another six months at least. Can it wait until we go home? Or should we seek treatment here?

The ideal time to treat Legg-Calvé-Perthes Disease is before the head of the femur collapses from loss of blood supply. But knowing when this might happen requires a crystal ball. X-rays and other imaging studies don't show this collapse and can't predict it.

By the time the hip progresses to the point of collapse, it may be too late to preserve the shape of the femoral head. Treatment before the age of eight seems to get the best results. And treatment this early means non-operative care may be enough.

The goal of conservative care is to maintain motion, reduce inflammation, and keep the head of the femur in the socket. This can be done with anti-inflammatory medications, traction, and sometimes bracing. When these measures fail, surgery to correct the problem is possible.

There's no reason not to try a course of nonoperative care wherever your location. It will take six months to see if this plan of action works anyway. Then you can have the surgeon at home review the case and plan the next step.