From the Research
Perthes disease should be managed with a focus on maintaining hip mobility and preventing deformity, with treatment depending on the child's age, extent of femoral head involvement, and disease stage, as evidenced by the most recent study 1. The goal of treatment is to maintain hip mobility and prevent deformity while the femoral head heals and reossifies, which can take 2-4 years. Key considerations in managing Perthes disease include:
- Age at onset, with younger children having a better prognosis
- Extent of femoral head involvement
- Maintenance of femoral head sphericity
- Regular follow-up with orthopedic specialists until skeletal maturity to monitor for complications like early osteoarthritis Treatment options may include:
- Observation with activity modification and regular follow-up for mild cases in younger children
- Containment therapy, which can be achieved through bracing or surgical interventions like femoral or pelvic osteotomy, for more severe cases or older children
- Pain management with NSAIDs like ibuprofen
- Physical therapy to maintain hip range of motion According to the most recent and highest quality study 1, there is no robust evidence regarding the most effective non-surgical interventions for the treatment of children with Perthes' disease, highlighting the need for further research. However, the study 2 suggests that advanced MRI imaging may help detect patients at risk earlier, leading to earlier surgical intervention, and that acetabular reorientation techniques, such as triple osteotomy, may be favored due to their biomechanical advantages. Overall, the management of Perthes disease requires a comprehensive and individualized approach, taking into account the child's specific needs and circumstances, as well as the latest evidence and research findings 1, 2.