We’ve been told that treating Perthes disease for some children with casting just isn’t worth it. Surgery is really the recommended treatment. Why doesn’t the less invasive cast method work any more?

Cast immobilization was the standard treatment for Perthes disease until surgical methods were developed to hold the hip in place without the severe movement restriction required by casting. Bracing has also been tried but studies show that brace treatment isn’t very helpful either.

It’s difficult to design a brace that is comfortable but still does its job of holding the legs apart and the head of the femur (thigh bone) in the hip socket. The child can’t walk with a brace or cast. The effect this has on attending school and participating in social events is negative enough to find some other way to treat the problem.

Parents both working outside the home also makes casting or brace immobilization a poor practical choice for everyday living. That’s why surgeons have found alternative ways to treat this problem — namely with surgery. Today every effort is made to contain (hold) the hip in the socket during the necrosis and revascularization phases of this condition. Necrosis refers to the period when loss of blood to the bone results in the death of bone cells. Revascularization is the restoration of normal blood supply.

There are different ways to contain the femoral head. Two of the better known (and most often used) methods are called femoral varus osteotomy and Salter innominate osteotomy. A third approach is the triple pelvic osteotomy — using the bones on three sides of the femoral head (pubic bone, iliac bone, ischium) to hold the head of the humerus firmly in place.

The surgeon uses tools and instruments to cut the bone in the pelvis, shift the pieces of bone, and reshape the bones to form a holding container around the femoral head. This type of surgical containment of the femoral head in the hip socket is safe and effective in the treatment of severe Legg-Calvé-Perthes disease. Using the triple pelvic osteotomy surgery can reshape the head of the femur into a round sphere that stays in the hip socket.

The final result is a pain free, functional hip that can eliminate differences in leg length, and restore a normal walking pattern without a limp.