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Our four-year-old grandson has been diagnosed with Perthes hip disease. The parents (our daughter and son-in-law) are trying to find out if surgery is needed. What are the indications for surgery? If surgery isn't needed, is there some other type of treatment instead?
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Legg-Calvé-Perthes Disease is a condition that affects the hip in children between the ages of four and eight. The condition is also referred to as Perthes disease. It was named in honor of the three physicians who each separately described the disease.
In this condition, the blood supply to the growth center of the hip (the capital femoral epiphysis) is disturbed, causing the bone in this area to die. Hip pain, limited hip motion, and a limp bring the child into the physician's office for diagnosis. The blood supply eventually returns, and the bone heals. But how the bone heals determines how much problem the condition will cause in later life. This condition can lead to serious problems and even permanent deformity in the hip joint later in life.
Treatment centers around the main goal of preventing deformity of the femoral head. When prevention isn't possible, then minimizing the damage to this area is the next best approach. Treatment varies depending on the age of the child at the time of diagnosis. Long-term management for adults affected by this condition during childhood is another aspect of treatment.
The surgeon's challenge is being able to tell which child needs surgery and when. X-rays and MRIs are used to get a handle on where the bone is affected, how much damage is present, and what kind of blood supply is present.
Studies show that surgery is needed when there is a large area of the femoral head and epiphysis affected. Earlier treatment (in children up to eight years old) yields better results. Treatment is more difficult when the femoral head has already fragmented and/or collapsed.
Some surgeons try conservative (nonoperative) care using a cast or brace to hold the hip in place. Sometimes a removable brace is used for a long period of time (up to a full year). The brace is worn at night. During the day, the child is allowed to move the leg and get around with a walker or crutches. Weight-bearing on the leg is NOT allowed.
When surgery is indicated, there are several different ways to approach the problem. All of the surgical techniques are designed to provide a deep hip socket for the femoral head and restoration of the normal, round head that fits inside the socket. Sometimes surgery involves cutting some tendons to change the angle of pull on the joint while building a shelf over the femoral head to hold it in place.
There hasn't been enough research yet to really pinpoint which procedure works best for each individual child. Decisions are made based on the age of the child, condition of the bone, presence of bone fragmentation, and loss of blood supply at the time of diagnosis. The younger the child (under age six), the more likely conservative care can be effective. Older children are almost certain to need surgery to prevent hip deformity.
Management of this conditionwith new treatment ideas may be developed in the near future. As more information about the cause and pathogenesis of Legg-Calvé-Perthes disease becomes available, studies can be done to find predictive factors to guide treatment. This will be a tremendous help to all who are trying to provide the best outcome possible for children with this disease.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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