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2 Legg-Calve-Perthes disease; Perthes disease
2 Is a degenerative disease of the hip joint,
where growth/loss of bone mass leads to some
degree of collapse of the hip joint and to
deformity of the ball of the femur and the
surface of the hip socket. The disease is
characterized by idiopathic avascular
osteonecrosis of the capital femoral epiphysis
of the femoral head leading to an interruption
of the blood supply of the head of the femur
close to the hip joint.
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2 accurs most frequently in boys 3 to 12

years old.
2 Caucasians are affected more frequently
than other races
2 Males are affected 3-
3-4 times more often
than females
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2 lthough no-
no-one has identified the cause of
Perthes disease it is known that there is a
reduction in blood flow to the joint. It is thought
that the artery of the ligamentum teres femoris
closes too early, not allowing time for the
medial circumflex femoral artery to take over.
2 For example, a child may be 6 years old
chronologically but may have grown to 4 years
old in terms of bone maturity. The child may
then engage in activity appropriate for a child
of 6 but may not yet have the bone strength of
an older child, leading to flattening or fracture
of the hip joint.
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2 Gnee pain (may be the only symptom, initially)
2 Persistent thigh or groin pain
2 trophy (wasting) of muscles in the upper thigh
2 Slight shortening of the leg, or legs of unequal
length
2 Hip stiffness restricting movement in the hip
2 Difficulty walking, walking with a limp (which is
often painless)
2 Limited range of motion
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2 º-rays
2 Bone scans
2 Magnetic Resonance Imaging (MRI)
2 rthrograms - a diagnostic imaging test to
study the non-
non-bony structures of joints.
2 Blood tests
2 Erythrocyte sedimentation rate - elevated if
infection present


2 The aim of treatment is to protect the bone and joint
from further stress and injury while the healing process
takes place.
2 rest
2 activity restrictions
2 medications
2 bed rest and traction
2 casting or bracing (to hold the femoral head in the hip
socket, permit limited joint movement, and allow the
femur to remold itself into a round shape again)
2 physical therapy (to keep the hip muscles strong and to
promote hip movement)
2 crutches or wheelchair (in some cases)
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2 surgery (to hold the femoral head in the

hip socket)
2 Inominate osteotomy
osteotomy;; varus osteotomy
osteotomy;;
osteotomy of the proximal femur,
acetabulum (Salter innominate
innominate), ), or a
combination of these may be required
2 ather than surgery; NSIDs such as
Motrin help with the pain inflicted.
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2 
 - Blood supply is absent to the
femoral head and the hip joint becomes
inflamed, stiff, and painful. Portions of the bone
turn into dead tissue. The ball of the thigh bone
becomes less round in appearance on x- x-rays.
This phase can last from several months up to
one year.
2 ë



 - The body cleans up the
dead bone cells and replaces them with new,
healthier bone cells. The femoral head begins to
remodel into a round shape again. The joint is still
irritated and painful. This phase can last from one
to three years.
2 ë








 - The femoral head
continues to model itself back into a round shape
with new bone. This phase lasts for one to three
years.
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 - Normal bone cells replace
the new bone cells and the remodeling continues.
This last phase can last a few years to complete
the healing process.
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2 asteoarthritis may develop later in life,

although the development of
osteoarthritis may be minimized with
prompt recognition and proper treatment.

 

2 The outcome is usually good with treatment.

Most bone will heal with minimal lasting
deformity.
2 Children younger than 6 have the best
prognosis since they have time for the dead
bone to revascularize and remodel. Children
that have been diagnosed with Perthes
Perthes''
Disease after the age of 10 are at a very high
risk of developing osteoarthritis