Posted by Scott Hendry on March 21, 2004 at 10:06:53:
In Reply to: Daughter with Perthes age 10 posted by Judy Bruce on March 16, 2004 at 12:24:10:
Judy -
My son was diagnosed with Perthes in the right hip early October of 2003 - he had just turned 11. Like your daughter, my son Chris was very much into athletics. We also sought 2 opinions and got 2 different recommendations. I would recommend that you start doing something - the wait and see approach doesn't sound right given your daughter's limited movement. The couse of treatment depends on how much of the ball is affected (Chris has 75% affected) and what your daughter/family is comfortable with in terms of surgery, life-style change.
Our family decided on a course of action through finding out about other's personal experiences in treating the disease. We opted for non-surgical treatment.
Chris is being treated by Dr. Perry Schoenecker at St. Louis Children's Hospital - he is one of the best Pediatric Orthopedic surgeons in the midwest and does basic research into the interruption of blood to the femoral head, the cause of Perthes.
Our course of treatment is containment of the ball in the socket through first a tendon release (minor surgery compared to shelf or osteotomy) and Petrie casting for 7 weeks and subsequent bracing with an A-Frame brace. We have found/believe that effective containment and maintenance of good range of motion is the key to getting through the disease. It has been explained to us that as long as the ball stays in the socket and can move with decent range of motion, the ball/socket will help reshape itself as the ball dies/softens/regrows. The key to this is non-weight bearing, physical therapy and lots of patience. Of course, this is not the easiest route: Chris uses a wheelchair at school and has to be in his brace 18 hours a day. He is starting to stand for short periods in the brace and at some point will be able to crutch with them (still not sure how that will work). He will probably be in this scenario for another year or so.
Although tough mentally/socially for the several year duration, we feel it will give Chris the best outcome for normal to near-normal motion for the long run.
Good luck with whatever course you decide.
Scott Hendry