Perthes Disease (Pediatric)
What is Perthes disease?
Legg-Calve-Perthes, more commonly called Perthes disease, is a condition that affects growing children, most commonly boys between the ages of 4 and 8 years old, in which there is a decrease in the circulation of blood to the head of the femur.
What causes Perthes disease?
The true cause of Perthes is unknown despite decades of research. We do know that there are several stages of Perthes and includes the ischemic stage when the bone cells in the head of the femur are not getting enough blood causing avascular necrosis (AVN). The next stage is fragmentation when the body is trying to replace the dead bone cells with new healthier ones. The following stages are reossification when the new bone cells are still lying down and remodeling when the new bone cells continue to heal. The whole process can take years to complete. There are currently no preventative measures for Perthes.
How is Perthes disease diagnosed?
Perthes disease is almost always diagnosed with x-rays of the hip, usually performed after a child is brought to the doctor with complaints of hip or leg pain or is noticed to have a limp when walking. An MRI may also be obtained in order to assess the amount of the femoral head involved.
How is Perthes disease treated?
There are several different ways to treat Perthes disease, ranging from simple observation to active treatments, such as surgery. For many children, particularly those younger than 6 years old, regular checkups with diagnostic x-rays are the best way to manage the condition.
The prognosis for the outcome is dependent upon the age of presentation with the older children usually requiring more extensive treatment.
Conservative treatment consists of the use of non-steroidal anti-inflammatory drugs (NSAIDs) in conjunction with a reduction in running or jumping and an addition of physical therapy in order to maintain range of motion as well as preserve the shape of the head of the femur.
If surgical treatment is recommended then it may include a pelvic or femoral osteotomy (cut in the bone) to arrange the bones to provide the best possible outcome once the femoral head remodels. It may or may not include soft tissue (muscle) releases to improve the ability of the femoral head to sit deeply in the socket.
Children who suffer from Perthes are limited in activities that they can participate in and may have difficulty adjusting. Swimming and bike riding are great athletic activities for a child with Perthes.