Surgical Treatment for Perthes Disease
Surgery for Perthes disease is usually reserved for children ages seven and older whose symptoms are less likely to be managed effectively by physical therapy or a cast. Depending on your child’s symptoms, orthopedic surgeons at Hassenfeld Children's Hospital at NYU Langone can help you to choose the most appropriate surgical procedure.
Before surgery, the orthopedic surgeon and any other specialists caring for your child discuss the procedure with you and address any questions you have. The doctors can tell you what to expect during recovery and whether your child may need assistive devices, such as crutches, or physical therapy.
Core decompression is an outpatient procedure performed in the hospital that may be used to help the hip joint heal on its own. During this procedure, the surgeon drills a hole into the ball of the hip joint, also known as the femoral head, which relieves pressure and allows for the growth of new blood vessels. This procedure is often combined with bone grafting, in which the surgeon transplants healthy bone tissue, usually from the child’s pelvis, into the hip to stimulate healing.
Core decompression surgery is only recommended in the early stages of Perthes disease, before the femoral head has collapsed, or flattened, and no longer fits neatly into the hip socket, known as the acetabulum. After core decompression surgery, the hip joint usually heals in two to three months, although it may take longer if bone grafting has been performed. Children who have this surgery may use crutches during this time to avoid putting pressure on the joint.
Tenotomy is an outpatient surgical procedure used to loosen a tight tendon in the hip joint. First, your child’s doctor uses a small needle to inject dye into the hip joint, highlighting the area on an X-ray. Then, the surgeon makes a tiny incision in the groin and severs a tendon in the hip called the adductor. The tendon grows back within a few months, allowing your child to move his or her hip more normally.
After surgery, your child may be fitted with a Petrie cast to keep the femoral head embedded in the socket as the joint heals. Your child may also need to use crutches until the tendon grows back and he or she can walk comfortably.
Osteotomy is a procedure in which the surgeon resets misshapen bone and secures it within the hip socket by deepening the socket or changing the position of the femoral head. Internal pins and plates may be used to hold bones in place as they heal. These are usually removed in a minor surgical procedure several months later.
Osteotomy of the hip is a complex procedure. Children who undergo this surgery often recover in the hospital for two to three days.
Our doctors may recommend hip distraction for children with more severe symptoms that cannot be treated using other methods. During this procedure, the surgeon attaches a device, called an external fixator, to the outside of the hip with pins or screws. The fixator gradually reduces compression in the hip joint, allowing it to heal without harming tendons and ligaments, a process called distraction osteogenesis. In children with severe symptoms, hip distraction may be combined with core decompression surgery.
Children usually remain in the hospital for two to three days after the fixator is attached. The device may be kept in place for three to six months. Because it provides stability, children are still able to walk while wearing an external fixator.
To help children regain mobility after surgery, our doctors may recommend the use of assistive devices, such as crutches, and physical therapy, which can help your child to regain range of motion in the hip during recovery.