Perthes disease, also known as, Legg-Calve-Perthes disease, is a rare childhood condition that affects the hip joint. This occurs when there is a lack of blood flow to the ball of the ball and socket joint. Without the necessary amount of blood flow, the bone cells die causing structural damage to the ball. Perthes disease occurs gradually, usually over the course of 1-2 years. Perthes is most commonly found in boys than girls, and both hips are affected only about 10% of the time. Typically, this disease occurs in children aged 4-10 years old.
An early symptom of Perthes disease is a change in the way your child walks and runs. This can include limping or having limited motion due to pain or irritability in the hip joint. Pain may also be present in the knee, groin, or thigh areas. If you notice these symptoms, it may be time to get an evaluation from a pediatric orthopedic surgeon.
During the examination, your doctor will conduct a physical examination to assess your child’s range of motion in the hip as well as any discomfort. Usually, the diagnosis of Perthes Disease is made with x-rays and in some cases, an MRI may be needed. These scans will help your doctor determine the stage of the disease.
The goal of treatment is to relieve pain and other symptoms, protect the hip joint, and restore normal function of the hip joint. It is important to seek treatment for Perthes Disease, if left untreated, the femoral head can become deformed causing further hip problems into adulthood. There are many different treatment options available and will depend on the following factors: your child’s age, the amount of damage to the femoral head, and the stage of the disease. In all cases, children are monitored with x-rays for several years.
Children aged 6 and below may just require observation as they have a greater potential for developing new, healthy bone. In other cases, your doctor may recommend the following:
- Medication such as ibuprofen to reduce inflammation.
- Limiting activity to prevent putting too much stress on the femoral head and decrease pain.
- Physical therapy to prevent hip stiffness and keep the hip in motion.
- Bracing may also be necessary in order to hold the affected hip in a good position.
In more advanced cases or in older children, orthopedic surgery may be needed in order to re-establish proper alignment of the bones until healing is complete. The most common procedure for Perthes disease is called an osteotomy where the bone is cut and repositioned to keep the femoral head in place. A metal plate and screws are often used to hold everything together and removed after healing. The child is usually placed in a cast for about 6 weeks after surgery. After the cast is removed, physical therapy begins to restore muscle strength and range of motion. Your doctor will continue to monitor the hip with x-rays through the final stages of healing.
Most children with Perthes disease are able to return to normal activity following treatment. In severe cases where there is deformity remaining in the femoral head, further treatment may be needed.