Perthes Disease
Everything you need to know about the symptoms, complications, treatments, and prognosis of necrosis of the femoral head tissues.
Symptoms and Causes
Legg-Calvé-Perthes disease, commonly known as Perthes disease, occurs when the blood supply to the femoral head is interrupted. As a consequence of the lack of nutrients, the bone progressively weakens, loses its spherical shape, and the tissues die, which may eventually lead to hip collapse.
As a general rule, blood flow is restored spontaneously and the tissues regain their vitality. However, if the bone is unable to recover its spherical shape, complications may result in chronic pain or joint stiffness.
Perthes disease usually occurs in children between four and ten years of age and, with appropriate medical follow-up, has a favorable prognosis, although complete recovery may take several years. This condition does not affect adults; however, some individuals may experience sequelae resulting from damage caused by the disease during childhood.
Symptoms
The most common symptoms of Perthes disease are:
- Pain in the hip, thigh, or even the knee.
- Limping.
- Stiffness.
- Loss of hip mobility.
- Muscle atrophy in the thigh: part of the muscle tissue is destroyed, resulting in reduced muscle size and loss of strength.
In most cases, Perthes disease affects only one hip joint. It is very rare for both hips to be affected simultaneously.
Causes
Perthes disease is an osteochondrosis, that is, a disorder of the bone growth plate that typically occurs during a period of rapid growth. The causes that trigger the reduction in blood flow to the femur remain unknown.
Risk Factors
The risk of developing Perthes disease is higher in the following cases:
- Age: although it can occur in children of any age, it is most common between four and ten years of age.
- Sex: it affects males more frequently.
Complications
Perthes disease may lead to complications during adulthood. The likelihood of these complications increases with the age of the child at the time of diagnosis. The most common complications are:
- Permanent deformity of the femoral head.
- Hip arthritis.
- Hip osteoarthritis.
- Early hip degeneration.
Prevention
As the causes of Perthes disease are unknown, it cannot be prevented.
Which specialist treats Perthes disease?
Perthes disease is diagnosed and treated within the specialty of Pediatric Traumatology and Orthopedic surgery.
Diagnosis
The diagnosis of Perthes disease is based on the following tests:
- Physical examination: the hip is inspected and the area is palpated to identify abnormalities. In addition, the physician assesses whether movement causes pain, whether limping is present, and whether there is any limitation of movement.
- X-ray: X-rays are used to obtain images of the joint and determine whether there are changes in the bones.
- Magnetic resonance imaging (MRI): radiofrequency waves together with an electromagnetic field are used to obtain a detailed representation of the condition of the hip. It is not always necessary, as an X-ray is often sufficient.
Treatment
Perthes disease resolves spontaneously over time, with a greater likelihood of complete recovery in younger patients. Treatment focuses on promoting recovery and preventing short-term complications. In general, the following measures are recommended:
- Medication to manage symptoms: analgesics for pain relief and anti-inflammatory drugs to reduce swelling.
- Bed rest to relieve pain and reduce the weight-bearing load on the hip.
- Application of a brace or cast to maintain the femoral head in position and immobilize the hip. This is used when the bone is severely damaged or when the patient is unable to remain still.
- Physiotherapy to prevent muscle atrophy.
- Surgical intervention: surgery is generally reserved for children older than six to eight years when bone destruction is severe. Different procedures may be performed depending on the individual case:
- Osteotomy: the bone is cut and realigned to prevent deformities.
- Arthrodiastasis: the articular surfaces are separated to avoid compression and promote tissue regeneration.
- Epiphysiodesis: bone growth is temporarily or permanently arrested to facilitate restoration of the spherical shape of the femoral head.
