When juvenile osteochondrosis of the hip and pelvis presents in a child whose skeletal age exceeds 8 years, the clinical picture carries distinct implications. At this age, the acetabulum shows reduced elasticity, narrowing the window for non-surgical management to reliably restore adequate hip containment.
This protocol addresses children with a skeletal age greater than 8 years who have radiographic evidence of loss of hip joint containment, limited hip range of motion, and Herring lateral pillar classification of B, B/C, or C. In patients above the age of 8, the reduced acetabular elasticity makes the degree of containment loss and Herring classification central to treatment decisions. For Herring B and B/C cases in this age group, surgical therapy shows significantly better results than non-surgical treatment.
The structured protocol for this scenario involves surgical reconstruction to restore and maintain hip joint containment. The approach centres on pelvic osteotomy with acetabular reorientation — and may be extended with a procedure on the proximal femur when more advanced containment is required. Alternative surgical options focusing on the femur or pelvis alone are also defined within the protocol.
The complete regimen — including the specific procedures, their indications, sequencing, and any combined approaches — is available in the full structured protocol below.
DOI: 10.1007/s00402-025-05801-3