Perthes disease: symptoms, diagnosis and treatment

In Perth disease, the head of the femur gradually becomes soft. This happens due to the breakdown of bone. The body produces new bone itself to prevent degradation. This is called shape changes. Perthes disease occurs in children between five and eight years old. The condition is very painful for children. The disease is also known as Legg-Calvé-Perthes disease (LCP).

Symptoms

  • Pain in hip
  • Pain in knee
  • Long-lasting pain in the knee or hip
  • Lameness
  • Limited range of motion of hip

Diagnosis

If it is suspected that a child may have Perthes disease, an x-ray is taken. Changes in shape are often visible. Other tests are often also done to rule out other conditions. When the disease is still in the early stages, an ultrasound is sometimes made to see whether the joint contains fluid. This is often also visible on the X-ray as the joint space widens. A bone scan makes it clear where bone loss and regrowth can be seen. A bone scan shows when less bone is being produced. If repair work is carried out by the body in the hip, the bone scan often shows nothing unusual.

Course of Perthes disease

The head of the hip is subject to shape changes in Perthes disease. This is caused by the disruption of the blood supply. Bone cells die when too little blood reaches the femoral head. The blood supply restarts automatically after a while, so that the body replaces the dead bone tissue with the formation of new bone. In total, this process takes three to four years. Three in ten patients develop osteoarthritis later in life.

Therapy

Perthes disease is usually treated. Treatment depends on the stage of the condition and focuses on preventing the head from moving outside the head.

Bed rest

Initially, the patient is prescribed bed rest so that the hip is not moved unnecessarily. That reduces the pain. The patient can then leave the bed again, but the disease is not yet over. The shape changes in the hip often continue. By taking regular X-rays, doctors can monitor the progress of the disease. If necessary, treatment can be repeated with bed rest, walking on crutches, the use of braces or the temporary use of a wheelchair.

Operation

Surgery is considered if the head threatens to move beyond the hip. During surgical intervention, a wedge is removed from under the hip joint. This puts the head in a good position. The bone parts then grow back together after eight weeks. The patient can then use the hip freely again. However, the hip should not be overloaded. Physiotherapy helps to maintain high mobility in the joint. The reason why surgery is not immediately chosen is that the intervention often only helps temporarily. Perthes disease cannot always be stopped by surgical intervention, so the effects are sometimes minor. The wedge must also be surgically removed again. In occasional cases, operations are performed to change the position of the socket. No treatment leads to a hip like people without Perthes have.

Treatment in older children

Rarely, the disease occurs in children aged eight years and older. This is always more serious in older children. Often the hip has already suffered the necessary deformities. It will then not be possible to surgically place the head back into the socket. You can choose to attach a roof to the bowl. The protruding head is then veiled, which reduces the pain.

Cause

One in two thousand children develops Perthes disease. The precise cause is not clear. There are unproven theories about a clotting problem. Perthes is more common in some places in the world. It is not clear why this is the case.