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Perthes Disease

Perthes disease, also known as Legg-Calve-Perthes Disease (LCPD) is a disorder of the hip that affects children, usually between the ages of 4 and 8. Hip is the largest weight-bearing joint in our body. It is a ball and socket joint that allows movement of the upper leg. Perthes disease usually involves both hips. In this condition, there is a temporary loss of blood supply to the ball of the hip joint (the femoral head) that leads to death of the bone. Over the course of several months, the blood supply eventually returns back to the bone tissue and new bone cells gradually replace the dead bone.

Causes
The cause of Legg-Calve-Perthes Disease is not clearly known, however there are some risk factors. Children who are malnourished or have abnormal blood clotting may have a higher risk of developing Perthes disease. There is little evidence that Perthes disease is genetic.

Signs and Symptoms
Some signs and symptoms of Perthes disease include:

  • Walking with a limp
  • Discomfort in the hip
  • Limited range of motion of the hip joint
  • Knee pain

Some children with Perthes disease are more likely to develop osteoarthritis in the affected hip later in life.

Diagnosis
Your doctor will make a diagnosis based on your child’s medical history, a thorough physical examination, and X-rays.

Treatment
The goal of treatment for Perthes disease is to help the femoral head grow into a functional shape. This goal can be achieved using a simple concept called containment. Containment is a very simple concept where in the femoral head can be moulded as it heals, very similar to moulding plastic. When there is an interruption of the blood supply to the femoral head, the acetabulum (socket) is not affected. The acetabulum can act as a mould to help keep the femoral head round. The purpose is to hold the femoral head in the joint socket as much as possible. Movement of the joint is necessary for the health of the cartilage. Therefore, the hip is permitted to move and not held in one position.

In the past, casts and braces were used to hold the hip in place. However, casts and braces are not well tolerated by patients and therefore physical therapy, short term casting, and surgery are used. Surgical treatments for containment in Perthes usually include realignment of the femur, the acetabulum, or both.

Your child must be assessed until they are skeletally mature. In general, the younger the age of onset of the condition, the better the chances for full recovery.

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