Perthes Disease

Perthes disease (also called Legg-Calvé-Perthes disease) is a hip condition that happens when the blood supply to the ball of the hip joint (the femoral head) is temporarily reduced. Without enough blood, the bone becomes weak and can change shape over time. As blood flow returns, the bone slowly heals and rebuilds itself. Perthes disease most often affects children between the ages of 4 and 10, and usually involves only one hip. With early diagnosis and proper care, most children recover well and maintain good hip function.

What Causes Perthes Disease in Children?

The exact cause of Perthes disease is not fully understood. It occurs when blood flow to the femoral head is temporarily interrupted. Possible contributing factors include:

• Problems with blood circulation to the hip
• Genetic or environmental factors
• Delayed bone development
• Low birth weight
• Family history of the condition

It is not caused by injury, and nothing parents did caused the condition.

What Are the Symptoms?

Symptoms of Perthes disease may include:

• Limping
• Hip pain, groin pain, or thigh pain
• Knee pain (sometimes without hip pain)
• Stiffness or limited motion in the hip
• Pain that worsens with activity and improves with rest
• Decreased ability to run, jump, or play

Symptoms often start slowly and may be mistaken for a minor muscle strain.

When Should My Child See a Specialist?

You should see a pediatric orthopedic specialist if:

• Your child has a persistent limp
• Your child has ongoing hip, thigh, or knee pain
• Pain lasts more than a few weeks
• Your child avoids putting weight on one leg
• Your pediatrician is concerned about hip movement

Early diagnosis can improve treatment options and outcomes.

How Is Perthes Disease Diagnosed?

Diagnosis begins with a physical exam and evaluation of hip motion. Imaging studies may include:

• X-rays to look at changes in the femoral head
• MRI in early stages when X-rays may still appear normal

These tests help determine the stage and severity of the disease.

How Is Perthes Disease Treated?

Treatment depends on:

• Your child’s age
• Stage of the disease
• Amount of hip involvement
• How well the hip moves

Treatment goals focus on:

• Keeping the hip joint moving smoothly
• Protecting the shape of the femoral head
• Reducing pain
• Preserving long-term hip function

Nonsurgical Options

Many children can be treated without surgery, especially younger children. Nonsurgical treatment may include:

• Activity modification to limit high-impact sports
• Anti-inflammatory medications (as recommended by your provider)
• Physical therapy to maintain hip motion and strength
• Crutches to reduce pressure on the hip
• Bracing or casting to help position the hip properly

Surgical Options

Surgery may be recommended for older children or more severe cases. Surgical options may include:

• Procedures to reposition the hip for better joint alignment
• Osteotomies to improve how the femoral head fits into the hip socket

Surgery helps protect the shape of the hip as it heals.

What Are the Risks of Surgery?

When surgery is needed, potential risks may include:

• Infection
• Bleeding
• Stiffness
• Differences in leg length
• Need for additional procedures

Your child’s surgeon will discuss all risks and benefits in detail.

What Does Recovery From Treatment Involve?

Recovery depends on the treatment used and may include:

• Limited weight-bearing for a period of time
• Physical therapy to restore strength and motion
• Gradual return to activity
• Long-term follow-up to monitor hip development

Parents help by encouraging activity restrictions and therapy exercises.

How Long Does Recovery Take?

Perthes disease heals slowly. The full process may take 1–2 years, depending on severity and age. Many children can stay active by modifying their activity during treatment.

What Is the Outlook for My Child?

The outlook for children with Perthes disease is generally very good, especially when diagnosed early. Most children regain good hip motion and return to sports and daily activities without long-term limitations.