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Perthes disease is a self- limiting rare condition of immature hip caused by disruption of blood supply to the rounded head of the thigh bone. Blood provides oxygen and nutrients to your bone. Lack of circulation at the head of the thigh bone might cause the bone cells to die and is called avascular necrosis.
Even though the term “disease’’ is used, it is really a complex condition with a process of 4 stages that could last over several years (mostly from 2 to 5 years). It might develop gradually with no incident of trauma.
What causes it and who is affected?
The exact cause of this condition is unknown; however, there are certain genetic or vascualr factors that might play a role in development of this condition.
It develops in children between 4- 12 years of age and occurs five times more in boys than girls. In 10-15% of cases, both hips are affected.
However, the long- term outcome for children is good in most of these cases and after approximately 18 months- 2 years of treatment, children can mostly return to daily activities without major limitations especially in younger age.
Symptoms
Pain in the thigh, groin or knee while moving the hip joint or bearing weight on the affected leg.
• Limping on walking especially in earlier stages
• Stiffness and reduced movement of the hip with or without pain
• Reduced muscle size on the affected leg
• Pain and limping worsening with time
How to examine if the child is suffering from Perthes Disease
Unfortunately, there is no consensus on clinical tests alone that can determine this condition.
However, physical examination with your physical therapist or doctor along with medical history is helpful to get a better understanding. Usually, it is confirmed with the help of imaging that might Include:
• X- rays.
• MRI
• US
• Bone scan
• Blood tests (to rule out any other possible conditions that may involve infection)
It is important to get support from a medical team to diagnose Perthes disease correctly as the symptoms alone are not enough to diagnose it and differentiate it from other hip conditions such as Slipped capital femoral epiphysis and Juvenile Idiopathic arthritis.
Treatment of Perthes Disease
This mainly involves being regularly monitored by your doctor and physiotherapist and having the muti-disciplinary team support for the following:
Physical examination
Pain Medications
Physiotherapy to help with hip movement and strength
Advice regarding sport activities
The four stages is explained in detail by your GP/ consultant and/ or your physiotherapist and the findings/ impression from your medical reports. Physiotherapy might help to improve mobility, improve blood supply and keep improving strength in accordance with the main principle of management of Perthes disease that is to contain ball within the socket at the hip joint and the treatment depends on the ongoing phase of Perthes disease.
