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Our eight-year-old son just had surgery for Perthes disease. I admit I'm a worrier, but what will happen to him when he's older? Will this problem affect him his whole life?

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 capital femoral epiphysis (growth center of the hip) is disturbed. The bone in this area becomes necrotic (starts to die) without blood. The blood supply eventually returns, and the bone heals. How the bone heals determines how much problem the condition will cause in later life. This condition can lead to joint deformity and a poorly functioning hip. The primary goal of treatment for Perthes disease is to help the femoral head recover and grow to a normal shape. All treatment options for Perthes disease try to position and hold the hip in the acetabulum as much as possible. This healing process is referred to as containment. Treatment success can take several years. If conservative (nonoperative) care is not successful, then surgery may be needed. There are some long-term studies following children with Perthes disease into adulthood. Results seem to depend on the age of the child at the time of diagnosis. Early onset of Perthes (younger than five) may have a better prognosis. On the other hand, children who have surgery later (after age five) have better results than younger children. Surgeons have different ways of classifying and categorizing Perthes disease. They use X-rays to grade the severity of the disease. Amount of growth plate and bone involvement is a factor. So is the shape of the femoral head. The flatter the head and the more bone involved, the worse the prognosis. But this is not a life-threatening condition. The long-term effects can include limp (from one leg being shorter than the other) and hip arthritis. In some cases, further surgery and eventually hip replacement may be needed. But this is the exception rather than the rule.

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