Perthes Information - from 25th July 2009
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1. Default Section
1
. Initial Diagnosis?
Initial Diagnosis?
Perthes
Pulled Muscles
Growing Pains
Other (please specify)
2
. Age at diagnosis & Gender?
Age at diagnosis & Gender?
Up to 6 years of age?
6 years old or older?
Male
Female
3
. Where are you?
Where are you?
New Zealand
Australia
United States of America
UK or Europe
Other
More specific information about where you live
4
. Which hip?
Which hip?
Unilateral - right hip only
Unilateral - left hip only
Bilateral - right hip first
Bilateral - left hip first
Bilateral - don't know which was first
If bi-lateral, was one hip far worse than the other?
5
. Treatment received?
Treatment received?
Restrictions
Crutches, walking frame or wheelchair as needed
Traction
Bracing or casting (including callipers)
Tenotomy and petrie casting
Osteotomy - Femoral
Osteotomy - Pelvic
Other Surgery - Triple Osteotomy, Shelf Procedure etc (please identify below)
External Fixator
Other
6
. Age now?
Age now?
15 years or younger
16 - 25 years
26 - 35 years
36 - 45 years
46 - 55 years
56 - 65 years
66 years or older
7
. Do you have any of the following?
Do you have any of the following?
Limp
LLD (leg length discrepancy)
Other orthopaedic or musculoskeletal issues with your Perthes leg
8
. Hip replacement/resurfacing?
Hip replacement/resurfacing?
I need alternative hip surgery ie: osteotomy as an adult
I have had a hip replacement or resurfacing
I am on the waiting list for a hip replacement/resurfacing
I am considering the need for one
No need for one in the forseeable future
Other (please specify)
9
. Your general health?
Your general health?
I am and have been in good health
I have, or have had some minor health issues
I have, or have had some major health issues
I have had surgery (orthopaedic or musculoskeletal) other than for Perthes
Other (please specify)
10
. Any other information that you feel might be relevant
Any other information that you feel might be relevant
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