Have you ever wondered why age matters so much regarding the treatment of Perthes? We’ve said it before: children aren’t just “little adults.” In fact children heal much faster than adults. A child’s age is inversely proportional to their rate of bone remodeling. This means the older you are the slower your bones heal and strengthen!
What changes somewhere along the lines to slow things down? The growth plates, or epiphyseal plate, close. Boney growth takes place lengthwise and circumferentially but once the plates close the growth is determined. This happens somewhere around 16 in boys and 14 in girls but varies from individual to individual.
PERTHES BY AGE
0-6 Children that are under 6 at onset can expect observation and treatment of symptoms such as pain, limping, decreased range of motion. Typically, this involves rest, activity restriction, anti-inflammatory medications and wheelchairs or crutches as needed.
6-8 Children that are between 6 and 8 at onset have variable presentations which makes the disease stage a very important consideration. Many can be treated non-surgically, similar to those under 6 with the addition of bracing or traction. Others will require surgery.
8-11 For children between 8 and 11 at onset pelvic or femoral surgery is generally recommended to ensure proper containment of the femoral head within the acetabulum and prevent further damage.
Over 11 Children who are over 11 at onset typically do not respond as favorably to pelvic or femoral surgeries. Osteotomy and hip distraction with external fixation are newer surgical treatments which may be provided to these candidates.
For all ages, containment of the femoral head and preserving range of motion through physical therapy are cornerstones of care.
Adapted with permission from International Perthes Study Group, www.perthesdisease.org, Texas Scottish Rite Hospital, 2016.