PERTHES DISEASE
NON-SURGICAL
Over the 100 years since the discovery of Perthes, treatment has vastly improved due to research and the greater knowledge of the disease that this research provides. Methods of treatment used in the 1950’s to 60’s were severe as children were admitted to hospital and placed on bed rest for months on end. From then on treatment slowly improved over time, in the 1970’s to 80’s the aim of treatment was to restrict weight bearing on the hip, this caused the positioning the leg to occur in apparently beneficial positions with the use of various devices and braces. However, over time it was found that braces were not that beneficial and hence surgery became more popular. What this shows is that treatment has moved from something completely non-rational which involved placing kids on bed rest to in the present day and age a wide range of treatments such as surgery which have positive results.

In essence the goal ​of the treatment is to control pain and irritability while maintaining hip mobility and attempting to prevent additional hip deformity. To achieve this goal the majoirty of toadys treatment aims to ensure that the femoral head is in the correct positon in the pelvic socket, allowing remodelling to occur and reduce the possibly of osteoarthritis.

Today treatment depends on the complexity and severity of the condition, the age of the child, the medical history, overall health of the child and finally the expectations of the condition. However it is important to remember that treatment is usually based on the individual child; the most important factor involved in the treatment decision is the child themselves and what will be of the greatest benifit to them. It is important to remember that every individual is different and so is every case of Perthes.
There are a wide range of treatments available however it is important to remember that specialist will have different preferred treatments and also base the treatment on the individual the outcome of not only treatment, but also the disease itself is based on two key factors: the age of the child when diagnosed with Perthes disease and the severity of impact on the femoral head.

The following are a few descriptions of both non-surgical and surgical treatments that are available and brief descriptions of what is involved (please consult your specialist in regards to what treatment would be best for you) :​​
A List of possible non-surgical treatments:
Activity restrictions​
Many doctors will at the start of diagnosis refer to a 'wait and see' approach to see how the condition developes, during this time activity restrictions may be put in place and these may continue throughout the whole disease period. The main aim of restircting the childs activity is to reduce the impact placed on the hip. By the implementation of activity restrictions the overall outcome may be less severe and if pain experienced by the child, reducing activity can intern reduce the pain.
Physiotherapy​
Although there are mixed beliefs regarding the benefit of physiotherapy this is mainly because it is debatable when the best time for physiotherapy in be included in the treatment. More importantly it is known that physiotherapy can improve or maintain the child's range of motion and also build up muscle strength that is lost during the disease. Currently physiotherapy is used as a pre-operative and/or post-operative intervention, in association with other surgical treatments such as casts or traction or for those with mild severity of the disease.
Plasters/Casts​
There are various types of casts that are used in regard to treatment on Perthes, such as broomstick plasters or hip spica casts.The main aim of these casts are to contain the femur head in the hip socket, allowing the femoeral head to remold itself into a rounded shape. These casts can be quite limiting; the broomstick plaster consists of a ling-leg plaster from groin to ankle held in an 'A' shapped position with a 'broomstick'. While the hip spica cast is esentially the same but encases the body and all parts of the leg. These casts are usually made out of plaster paris and/or fiberglass and usually the child can only stand and walk for short distances with adualt supervision, causing them to become wheelchair bound or have to use crutches for the suration of their treatment. This severly impacts on transport, travelling, clothing, home life and school life.
Bed Rest​
Bed rest is a possible non-surgical treatment, however this treatment would only be used short term in an attempt to rest the hip for short periods of time, possibly trying to reduce the occurance of inflamation or rest from weight bearing.
Crutches/Wheel chair
The main use of crutches and wheel chairs is to avoid weight bearing on the hip, these devices can also be used in conjunction with a surgical procedure or other various treatments. It is important to take into consideration the age of the child and also their ability of using either crutches or a wheel chair, the other consideration is the environments they will have to use these in and wether they are wheelchair friendly.
Slings and Springs​
Slings and springs are used to allow the affected leg to relax and move freely by suspending the legs above the bed. The aim of this treatment is to increase the sideways movement of the affected hip and ensure that the position of the femoral head is adequately positioned in the hip socket. This treatment may be required to include overnight traction which is known to disturb sleep and may cause children to be sleepy and/or irritated.
Traction
Traction usually occurs in hospitals, the time frame of traction depends on the individual partient and can last from two days to a few weeks. Traction is a special device where weights are atatched to the childs leg(s) using bandages from ankle to thigh. It aims to provide a pull on the hip joint which causes the hip joint to be pulled open allowing the femoral head to be reseted and reduce impact on the femoral head.
TREATMENTS
SURGICAL
A list of possible surgical treatments:
External fixator/frame
This treatment is relatively new however is also the only procedure that completely unloads the femoral head and allows the cartilage to reform. The application of an external fixator or frame involves an external device which is attached to the upper thigh. It is attached with two groups of steel pins that are inserted through the skin and muscle into the bone of the thigh and pelvis. At the time of attachment the head of the femur is ‘pulled’ away from the cup of the pelvis by applying a pull of the thighbone. The fixator is then locked into position, and normally the fixator maintains the femur at a 15 degrees abduction. These fixators are used in an attempt to improve the blood supply to the hip joint. They are usually in place for 4 to 6 months, and after initial use of a wheelchair, the child can begin to use crutches and then advance to being able to walk independently.
Osteotomy
The aim of an osteotomy is to reposition the femoral head in the pelvic socket to allow it to remould in a rounded shape, it is performed at different stages of the disease depending on the need. What occurs during that procedure is that the bone is cut either in the thighbone or the pelvis head, depending on the positioning required, redirecting the ball of the femoral head into the socket. This reorientation is held in place and stabilised with metal screws and plates. After surgery weight bearing should be limited for the first 6-8 weeks using either a walker or crutches.
Tenotomy
A Tenotomy is an operation where the adductor tendon which has shortened due to limping is cut, releasing the tendon and helps loosen up the hip joint. After the surgery a cast is applied allowing regrowth of the tendon to a more natural length, this cast will remain on for six to eight weeks.
Core Decompression
The purpose of a core decompression also known as trans-neck-head tunnelling is to allow blood vessels from the upper femur to grow up through surgically made holes in the growth plate, resupplying circulation to the femoral head. The surgery involved is simple in that holes are drilled up across the growth plate into the femoral head and into the centre of the dead bone within the femoral head. However there are risks that are associated with this procedure such as fracture and growth arrest of the femoral head.
Shelf procedure
A Shelf procedure is where a bone graft is placed above the acetabulum to improve coverage and containment of the femoral head. This prevents subluxation (partial dislocation) and helps to evenly distribute the bodies weight. It also does not affect or distort the upper femur or acetabulum.
