Question
QUESTION: I have a daughter,age 13yrs now, with legg perthes. She had a shelf osteotomy on her lft hip at age 6yrs w/ pretty good result. the femoral head is resonably normal now w/ little to no pain. On the other hand, at age 7yrs, she started having problems w/ the rt hip. X-rays showed that the femoral head was almost out of the socket and was taken to surgery right away. Another shelf osteotomy was done and we were told she will probably have some problems w/ this hip.
They were right. Her last MRI showed the femoral head was egg shaped but in socket. My problem and question is that she has a lot of pain w/ her rt hip. It is almost constant and she takes ibuprofen,heat therapy and even steroid hip injections to little or no relief. Her doctor says she shouldn't hurt this much, but she does. He says she can't have a hip replacement until she's almost out of school.
Now that you've tolerated my story, this is my question: Does she really have to wait until she stops growing to get this done?  I just hate seeing my baby hurt!!

ANSWER: Shelly

I have never regretted my parents decision to allow me to have the THR at 16. It gave me a normal life. It is true that once a child has the surgery, they do stop growing, but at 16, I was almost at full height.

I truly hate to see your daughter suffer, and I know the type of pain she is in and it hurts badly.  

In answer to your question, I don't think there is a hard and fast rule to wait until she stops growing, but if she has the surgery, she will stop growing as her growth plates are affected by the surgery.

Please seek a second opinion, or even a third opionion so you do the best for your daughter.

Best of luck to you

Sharon

---------- FOLLOW-UP ----------

QUESTION: Can you think of anything else that might alleviate her pain?
She already takes ibuprofen 400mg-600mg every 6-8 hours.
We also use Therma-care heat wraps, especially when going to school. She was given a steriod hip injection once, but the procedure was soooo painful for her and she only got 5-7 days of relief. She absolutely refuses to have another without sedation. I can't say as I blame her. Any further suggestions would be most appreciated.

Answer
Hi again Shelly and thank you for your lovely comments.

The amount of over the counter ibuprofen your daughter is taking is equal to the normal dosage of prescription Motrin.  Be sure she eats something when she takes the ibuprofen since it may eventually start to irrate her stomach.

Ask the doctor if he can prescribe Tylenol with codeine, or one vicodin for her to take only at night.  It may help her with the pain so at least she can get a good night's sleep.  But be aware that doctors are not happy about prescribing narcotics to anyone and specifically kids.  I used to take darvon when I was her age and frankly it just made me dizzy and sick.  

The heat during the day may help, but frankly it's her bones that hurt and I think the heat helps muscle pain more than bone pain, but heating may soothe her so by all means continue that.

I would push for the doctor to prescribe the tylenol 3 or the vicodin at night only.  Taking it during the day will make her too sedate, but at night it will help her sleep and the residual affects of pain relief may stay with her for several hours during the day.

I have never had a cortisone shot in my hip, but I have heard that they do hurt badly.  So absolutely insisit that her doctor to sedate her.  He will probably give her valium or ativan an hour prior to the shot, but if she will still feel some pain from it.  She is too young to have to go through these procedures with little or no pain relief and you must insist on this for her.

Also do seek other opinions.  It may be that because her pain is so severe, they will do the replacements early.  Ask if there is any test that can be taken to see if she has reached her full height.  

best of luck
Sharon