Our son has Perthes hip problems but no one seems to want to help us find a way to treat this problem. Isn’t there some brace that works? What about surgery? Can’t they perform some kind of operation to correct this?

Bracing as a means of treating Perthes hip disease was a popular treatment approach 35 years ago. But according to a recent review, opinions are shifting on this one. The authors of the article did an extensive search of the published literature on this topic.

What they found was that treatment should be based on a classification system that divides patients by age and severity of disease. Mild disease (determined by X-rays) in younger children (five years old or younger) doesn’t really need active treatment. Careful observation may be all that’s required.

Bracing just doesn’t seem to change the anatomy or alignment of the hip. There are some children who might benefit but they must be evaluated carefully and selected individually for this type of treatment.

Eligible children are younger and have significant (more than 50 per cent) of the epiphysis affected. They also have chronic inflammation of the synovial fluid in the joint and partial hip dislocation. X-rays show involvement of the lateral pillar (outside portion of the femoral head). Children who meet these criteria may be the best candidates for bracing. Results should be followed closely and discontinuation of bracing if no benefit is observed.