How long will the needs last?
Physiotherapy and monitoring
Physiotherapy is an important aspect of treatment and the majority of the physiotherapy exercises will be done either with a parent or carer or under supervision. Such children will require help with their therapy on a daily basis. Typically exercises take around 15 minutes and are done twice daily.
Children will not require any extra help with care or mobility for the majority of the time. They will sometimes rest in bed or be mobile on crutches when the hip is particularly painful. They will require extra emotional help and support from their parents to deal with a painful condition especially if it restricts their life style. These children are often athletic and in all but the mildest cases sporting activities are likely to be significantly affected.
What is the prognosis and duration?
If care needs such as daily help with therapy are identified these can be expected to last for 2-4 years. A 2 year award is recommended to check that treatment including daily therapy by the parents is ongoing.
| Age at date of claim | Award Period |
|---|---|
Age 0 - 8 |
Award for 2 years |
Plaster cast or a brace
Broomstick plaster
Serial casts are rarely used in the UK. In these cases care and mobility needs related to the casts may be prolonged by more than 6 months. A child in broomstick plasters will be unable to walk normally. If they can weight bear to mobilise they will need crutches to get around. Mobilising with crutches in this type of plaster is tiring and the child may require a wheelchair for longer journeys and at school. Seating is difficult and adapted seating to accommodate the legs may be needed at school and at home too. Getting on and off a toilet may be difficult, if help is needed the parent is likely to accompany the child to school to provide such help. At home the parent is likely to provide help with both washing and dressing, the child will not be able to manage their shoes and socks and may need help with other aspects of washing and dressing related to their casts. Once the cast comes off the child is likely to resume walking normally very quickly. However additional care may be provided by parents if daily physiotherapy exercises are prescribed.
What is the prognosis and duration?
Duration of mobility and care needs will depend on whether broomstick plasters are being used as a one off treatment of the hip for 6-8 weeks only or as treatment over a period with serial casts. Serial casts would be unusual and should be confirmed in the medical evidence. It is recommended that awards related to casts be given until the projected end of treatment, if the date is not known then review after one year. Care needs may continue beyond the period in plaster if daily physiotherapy is prescribed. Children of 12 years of age can be expected to take responsibility for and do their own physiotherapy.
| Age at date of claim | Award Period |
|---|---|
0 – 11 - Cast being worn |
Award until projected end of treatment or award for 1 year if projected end of treatment date is not known |
0 – 11 - Ongoing therapy once cast is removed |
Award for 1 year in cases where continuing physiotherapy is required |
Hip spica
A hip spica is only likely to be used for 6-8 weeks either as sole treatment of the hip or to protect the hip after surgery. A child in a hip spica will be unable to walk normally.
If they can partially weight bear to mobilise they will need crutches to get around. The child may require a wheelchair for longer journeys and at school. Seating is difficult and adapted seating to accommodate the leg may be needed at school and at home. As one hip is unable to bend getting on to and off the toilet and balancing on it is likely to be difficult. If help is needed with toileting the parent is likely to accompany the child to school to provide such help. At home the parent is likely to provide help with both washing and dressing, the child will not be able to manage their shoes and socks and may need help with other aspects of washing and dressing related to their cast. Once the cast comes off the child is likely to resume walking normally very quickly. Once the spica is removed the child still has Perthes disease, the treatment simply puts the hip joint in a better position for healing – healing must still occur. Daily physiotherapy exercises may be required and parents will have to help with or supervise these.
What is the prognosis and duration?
Time in plaster is likely to be short and normal walking should be resumed within 6 months of starting the treatment. If care needs such as daily help with therapy once the cast is removed are identified these can be expected to last for 2-4 years. A 2 year award is recommended to check that treatment including daily therapy by the parents is ongoing. Children of 12 years of age can be expected to take responsibility for and do their own physiotherapy.
| Age at date of claim | Award Period |
|---|---|
Age 0 - 7 |
Award for 2 years |
Age 8 – 9 |
Award for 2 years |
Age 10 - 11 |
Award to age 12 (or for 1 year whichever is the longer) |
Orthotic brace
The child may or may not be able to mobilise by walking or running in the brace. If children can get around in a brace they will. They may be dependent on crutches or sticks for mobility. They will be able to get on and off the toilet by themselves and are unlikely to require help with this during the school day unless they are unable to walk.
The brace can be removed so the child can wash and a parent or carer will have been taught how to do this and will supervise the child during washing and bathing and reapply the brace afterwards. The parent will need to remove and refit the brace whenever the child gets changed, washes or goes swimming and supervise the child the whole time the brace is off, effectively either helping with or carefully supervising all washing and dressing. This treatment is rarely used in the UK and should be confirmed in the medical evidence.
What is the prognosis and duration?
Care will be required during the whole period in the brace. The brace will need to be taken off and put on again morning and evening and if the child goes swimming. Help may be required to putting clothes on and taking them off over the brace. If the child cannot walk in the brace mobility will be severely affected. Most children can walk in a brace and the majority use crutches to do this. Awards related to care and mobility in the brace should last until the brace is no longer worn. Typically the brace will be worn for 1-2 years. Once the brace is removed daily physiotherapy may be required, an award for ongoing physiotherapy once the brace is removed should be renewed after one year.
Children of 12 years of age can be expected to take responsibility for and do their own physiotherapy.
| Age at date of claim | Award Period |
|---|---|
0 – 11 - Brace being worn |
Award for 1-2 years depending on how long the brace is to be worn |
0 – 11 - Ongoing therapy once brace is removed |
Award for 1 year in cases where continuing physiotherapy is required after removal of the brace |
Surgical treatment
Osteotomy
Clearly, children who have had surgery and are non-weight bearing on crutches or in a hip spica whilst bone healing occurs, will not be able to walk for a period. The majority of such children should be walking normally within 6 months. Children who are still unable to walk at 6 months are likely to be those with the most severe disease, bilateral disease or complications of surgery. The majority of these will resume walking within a further 6 months to a year.
It is likely that these children will have ongoing needs for physiotherapy at home when they have recovered from surgery. It is likely that children will have extra care needs related to reduction in mobility after surgery for several months, but resume walking within 6 months of the start of treatment. Care needs related to ongoing physiotherapy once normal walking is resumed could be expected to last for up to 2 years.
What is the prognosis and duration?
Care needs relate firstly to surgery and then to ongoing physiotherapy at home. Walking difficulties are only likely to last longer than 6 months in cases where complications of hip surgery have developed or where the second hip is operated shortly after the first. A 1 year award is recommended. Children of 12 years of age can be expected to take responsibility for and do their own physiotherapy.
| Age at date of claim | Award Period |
|---|---|
0 – 11 |
Award for 1 year |
Age 0 – 11- Ongoing therapy once out of cast & weight bearing |
In cases where continuing physiotherapy is required award for 1 year |
Arthrodiastasis
The external fixator is likely to be in place for 2 months. Parents will need to follow a wound care plan to care for the pins during that period. They will also need to help with washing and dressing whilst the pins are in place. Once the pins are removed there may be an ongoing need for daily physiotherapy.
What is the prognosis and duration?
It is unlikely that wound care will be needed for more than 2 months and mobility is maintained through the treatment. There may be care needs related to physiotherapy following on from arthrodiastasis treatment. 2 year awards are recommended for care needs related to ongoing therapy. Children of 12 years of age can be expected to take responsibility for and do their own physiotherapy.
| Age at date of claim | Award Period |
|---|---|
Age 0 - 9 - ongoing therapy |
Award for 2 years |
Age 10 – 11 (and over) - ongoing therapy |
Award to age 12 (or for 1 year whichever is the longer) |
Note: Mobility needs are unusual with modern treatment. Normal walking ability resumes once child is out of plaster or brace. Daily physiotherapy treatment usually continues for a period after this.
