158 chapter 18
Treatment and progress of Legg-Perthes disease
When the growth center has lost its blood supply, the bone dies and
begins to break into pieces. At the same time, the body begins to make
new bone. In 2 to 4 years, a new growth center is completely formed,
and the child walks more or less normally again, usually without pain.
However, the new growth center is usually flatter than before and does
not fit into the hip socket as well. As a result, later in life, the hip joint
begins to wear out and a progressive, destructive, painful arthritis may
begin.
flattened, deformed
growth center
Many ways to treat Legg-Perthes have been tried. Most methods try to restrict
movement and to keep the legs wide apart, a position that makes the growth center
form a round and normal shape again.
Braces are kept on the child until the new growth center has
formed completely—usually for 2 to 3 years! This is very hard on
both the child and family.
cast
full-leg braces
upper-leg braces only
Any of 3 different hip surgeries can make the head of the thigh bone fit more
completely into the socket so the new growth center forms a rounder, normal shape.
Surgery is expensive and has more risks than braces. But it is much quicker: only 6
weeks in bed with a cast. Then the child can lead a more or less normal life. But it still
takes 2 years for the new growth center to form, and during this time the pain and/or
limp may continue.
Canes or crutches may be used to keep pressure off the hip joint and reduce pain.
Moderate exercise, like swimming, can help to maintain and increase range of
movement.
There is a lot of debate about whether any of these methods—casts, braces, or
surgery—are worth it. Especially for children under 6 years old, their pain and limp
gradually go away with or without treatment. The best advice in these cases may be to
do nothing. (This is a hard decision for parents to accept, but will make life happier for
both the child and family.) Let the child remain active, but do not make him run, jump, or
walk far if it bothers him. For older children, surgery may be the best option.
If the growth center heals to be rounded and fits well in the hip socket, the child will
probably not have problems with arthritis later in life. But if the growth center does not
reshape itself well, and especially if it doesn’t fit well into the socket, he might develop
arthritis earlier and more severely.
X-rays can help you decide what to do and what to expect when a child has
Legg-Perthes.
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