Pediatric Orthopedics

Perthes Disease

What is Perthes disease?

Perthes disease is one of the common hip problems seen in children. Perthes Disease develops following the temporary interruption of the femoral head blood supply. The loss of blood supply causes osteonecrosis in the femoral head. Since the necrotic bone looses its strength, a fracture in the femoral head in these very active youngsters may occur and the disease process begins. Then, necrotic bones are removed by osteoclasts and new bone is formed by osteoblast cells.

In which age group is the disease common?

 

Perthes disease is commonly seen  in children between the ages of 3-10 years. Perthes disease is very common in boys than girls 4 times.

What are the clinical findings ?

Limping, hip and/or knee pain are the most common clinical signs. The findings of the patients from time to time exacerbated and from time to time become lighter. During the examination, joint movements range of motion may show limitation. Atrophy in the thigh muscles is frequently seen can be documented with thigh circumference measurement.

How can Perthes disease be diagnosed?

Perthes disease is diagnosed with medical history, physical examination and radiography. The majority of cases, MRI or CAT scan in the diagnosis of Perthes disease is not needed. However, MR can be very helpful in early diagnosis when the radiographs are normal.

What is the treatment?

The main objective in the treatment of Perthes disease is to maintain joint range of motion. Especially  rest and anti-imflamatory medicine treatment is  recommended in painful periods. Perthes disease process can long up to 2-2.5 years. In this process, extreme sports activities, participation in the sports with  high jumping activities, and contact sports should be avoided as much as possible. However, the child could do her/his  daily activities.

During the process of necrotic bone rezorption and new bone formation, the femoral head is also reshaped. To have a spheric and congruent femoral head, the femoral head should be kept in the acetabular socket.  Orthopedic surgeon follows patient radiologically whether femoral head epiphysis loose its height and /or shows profusion out of the socket. Orthopedic surgeon may recommend surgical treatment, if he or she sees any radiological hip risk signs. Eventhoug some orthopaedic surgeons may recommend the use of an abduction orthoses, we do not prefer to use or theses in the Perthes treatment. They are cumbersome and very difficult to use.

How is the course the disease? Is sequelae remains?

Clinical course of the Perthes disease depends on the patient’s age and the amount of involvement. As a general rule under 6 years of age show excellent and almost complete healing.  Whereas, the course of the disease is more  severe in patients over the age of 8 years.

 

 

 

 

 

About the author

Prof.Dr. Seref Aktas