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We have kind of a weird family situation. One grandchild has a hip problem called Perthes disease. The other one has developmental hip dysplasia (kids are from two different families). They are both having surgery to fix the problem but I heard that the Perthes disease is the harder problem to fix. Is this true?
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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 Legg-Calvé-Perthes disease 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. The blood supply eventually returns, and the bone heals.
The primary goal of treatment for Perthes disease is to help the femoral head recover and grow to a normal shape. The closer to normal the femoral head is when growth stops, the better the hip will function in later life. The way that surgeons achieve this goal is using a concept called containment.
Treatment can be nonoperative but if this fails, then surgery may be needed to realign the hip and achieve containment. Sometimes it is necessary to surgically dislocate the hip during the procedure. Doing so gives the surgeon a better idea of the full extent of hip deformity and the knowledge needed to realign the bones. Surgical dislocation comes with a few extra problems to watch out for such as damage to the nerves or blood vessels in the area.
Dysplasia means the hip socket is too shallow to hold the femoral head in place. Partial or complete hip dislocation is often the result. Surgery to realign the femoral neck and femoral head and to reshape the hip socket may be required.
In both Perthes and hip dysplasia, a particular procedure called femoral osteotomy is often used to regain a more natural hip anatomy. In the case of Perthes disease, the lack of blood supply can make the procedure one notch more difficult than reconstruction for hip dysplasia. But fortunately in today's more modern approach, MRIs can be used to map out the pathway and location of the blood vessels to the hip. This careful assessment can help the surgeon minimize complications.
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