Perthes Disease is a hip condition that affects active children between the ages of 4 and 12. No-one knows why, but in children with Perthes disease the blood supply is lost from a portion of the femoral head. The body reacts to take this dead bone away, which can result in the femoral head not staying round.
Young patients have time to heal the femoral head whereas older children have less growth remaining. The amount of the femoral head that has been involved by the blood supply issue is also very important. MRI using a contrast agent is useful in determining exactly what parts of the femoral head are involved. After that the shape of the head and its position in the socket can be monitored with x-rays, usually every 3 months.
Many cases of Perthes disease can be treated without an operation. Surgery has been shown to help in certain kinds of cases, depending on the age of the child and how much of the femoral head is involved. I prefer to keep the children off their hip as much as possible, even though this sometimes requires them to use a wheelchair. This also helps control pain and inflammation.
There are many different opinions on how to treat Perthes. My approach is very much a contract with the family and the child on how we will work together on each individual case.