Dakota's Diagnosis - Perthes

So our journey with Perthes started back in June of 2010. My son, Dakota, had been limping for about a month at that point and after trying everything I could at home to take care of it, I decided it was out of my hands and hauled him into the doctor's office.


They right away did a series of x-rays and didn't find anything to be wrong with the bone, so they sent us home. I waited another month. One night, while sitting on the floor watching TV Dakota tried to stand up and just winced in pain. "It's breaking" he said. The next day, I took him back in to see the doctor. And once again, another series of x-rays was ordered. This time, however, the bone showed a slight fracture. This is when Dakota's primary care physician diagnosed him with Perthes.


Perthes is a condition in children characterized by a temporary loss of blood supply to the hip. Without an adequate blood supply, the rounded head of the femur (aka the "ball" of the "ball and socket" joint of the hip) dies. The area becomes intensely inflamed and irritated. Although the term "disease" is still used, Perthes is really a complex process of stages. Treatment may require periods of immobilization and/or limitations on usual activities. The long-term prognosis is good in most cases. After 18 months to two years of treatment, most children return to normal activities without major limitations. Perthes' severity is graded on an A, B, C scale. "A's" are usually treated with just limitations on activities. "B's" are usually put on crutches (which we were told to use for a month) and have limited mobilization and "C's" are treated with surgery. We got sent to a specialist, who by the way is just super helpful and understanding. He ordered a MRI for Dakota that same day and had us come back about 3 days later to look at the scans. The scans confirmed that Dakota's entire ball joint was dead and the doctor classified his severity to be "between a B and a C". Because of Dakota's age (he is on the older end of the age range) and the B/C classification the doctor and I agreed it was in his best interest to have the surgery done to try and correct it before it collapses on him.


Surgical treatment re-establishes the proper alignment of the bones of the hip. The head of the femur is placed deep within the socket. This alignment is kept in place with screws and plates, which will be removed about a year later. Over time the ball joint will collapse and start to look a little like swiss cheese. After the collapse occurs, new growth will start to form and because of the plate that was inserted, the bone will grow correctly into the socket area. After he has been released from the hospital, he will have to be on bed rest for two to three weeks depending on how recovery goes. He won't be allowed to move at all. I will be homeschooling Dakota with help from a home bound teacher, so that he doesn't fall behind in his studies. Then, based on how well he bounces back from surgery, he will eventually get put in a wheelchair and then again eventually be put back on crutches while going through physical therapy to re-learn to walk.


So our surgery date is set for September 22, 2010. Until then, we have been given a wheelchair that he has to use, so that no weight is being put on his hip. We had our pre-op appointment this morning and that went very well. He is a very healthy boy, besides the Perthes! He is a trooper and hasn't complained once about having to live life in a wheelchair. I am so blessed, because there are so many out there who will never be able to live life without a wheelchair. My son, at least, will be able to run and walk and play sports again some day. I need constant reminders that, "This too shall pass!" We are a strong team, him and I and this will only make us stronger!


I have included pictures (below) to show what Perthes looks like before it's been surgically operated on and then after the operation.

Perthes on the right (left leg) - ball joint is flatter and outside socket area - this is a very severe case, Dakota's doesn't look this bad.

After the leg has been operated on and had the screws and plate inserted. You can see where they try and re-position the ball so that when it grows back it grows into the socket area.