We just left the orthopedic surgeon’s office after a meeting to talk about surgery for our daughter. She has Perthes hip disease. They are saying it will be necessary to dislocate her hip during surgery in order to correct the impingement problem she has. This sounds pretty drastic to us. What do you think?

Children with Perthes disease of the hip may recover fully without further hip problems later. But those with growth disturbance of the femoral head and altered shape of the normally round femoral head (top of the thigh bone) may end up with femoroacetabular impingement (FAI).

Surgery to correct the impingement is a possible treatment option. Careful assessment of all deformities and damage present in the hip complex can be done best with surgical dislocation.

The surgeon must look at both sides of the hip: the femoral head and the acetabulum (socket). It may be necessary to make surgical corrections of both areas. And that means surgically dislocating the hip in order to visually inspect everything and form a surgical plan.

On the femoral side, the surgeon may change the length or angle of the femoral neck. The misshapen and enlarged head may have to be corrected, a procedure called osteochondroplasty. This also requires surgically dislocating the hip. That sounds pretty dramatic but it can be done safely and is quite effective.

While correcting the deformity that causes impingement, the surgeon will also look for any other areas of soft tissue damage. There may be a tear in the labrum that needs attention. The labrum is a rim of cartilage around the hip socket designed to give the socket a little bit more depth and the hip greater stability inside the acetabulum.

The ultimate goal of surgery for femoroacetabular impingement in the Perthes hip is to improve hip joint motion. Reducing pain and improving joint stability are also important. The surgery can become quite complex when there are numerous changes in the hip to be addressed.