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Perthes disease, also known as Legg-Calve-Perthes disease, is a vascular blood supply abnormality of the growth plate of the femur head at the hip joint that affects children. The bone tissue in the femoral head loses its vitality as a result of the blood supply problem, and avascular necrosis develops. Perthes disease has been defined for more than a century, yet its origin and treatment are still unknown.
In general, orthopedists’ treatment preferences are determined by the patient’s age, radiological appearance, and examination findings. The major goal of both non-surgical and surgical therapy is to relieve the child’s hip discomfort, preserve the joint’s range of motion, and assure the hip joint’s balance. As a result, femoral head deformity and articular cartilage injury can be avoided in the early stages, and the joint can be kept from becoming calcified in the future.
The disease’s prevalence varies between 0.2 and 19.1 per 100,000, according to research. Perthes disease is most frequent in children between 4 to 10, but it can occur at any age throughout the development of the skeleton. Boys are more likely than females to develop it. Although it normally affects only one hip joint, around 10% of people experience pain on both sides. There’s not much proof of a hereditary susceptibility. It is assumed to be linked to environmental variables because it is rarely observed jointly in twins.
The most important factor in the development of Perthes disease is the concept of “susceptible child.” Hazards such as abnormal growth and development, malnutrition, hip joint damage, hyperactivity, attention deficit, environmental factors, and cigarette exposure are included in the classification of a susceptible child. When x-rays of the wrists of children with Perthes disease are compared to those of their classmates, there is a delay in bone age.
There has yet to be established a definite relationship between the disease’s onset mechanism and growth restriction. Sickle cell anemia, thalassemia, leukemia, lymphoma, hemophilia, and coagulation disorders are among conditions that might cause a blood supply problem in the femoral head’s growing cartilage. The actual origin of Perthes disease, on the other hand, has yet to be discovered.
The fact that the child limps while walking is usually the first thing that parents notice. Physical effort makes lameness worse, while rest makes it better. Pain is the second most common complaint. Children may complain of pain in their hips, groins, thighs, and knees. Pain rises with physical activity and peaks, particularly in the evening hours. Perthes disease is characterized by nocturnal hip discomfort. The development of a restriction of mobility in the hip joint is another sign.
Patients’ family frequently discuss a previous trauma and claim that the discomfort goes away after resting. They could argue, for example, that their children are more active than other kids and that they run and jump more. These children are often compared to their classmates since they are retarded and younger. On the other hand, it’s important to remember that Perthes disease might manifest itself in a child who is fat and inactive.
Although the natural course of Perthes disease is influenced by variables such as age and the degree of femoral head involvement, there is no clarity on the significance of these risk factors. The impact of the disease’s beginning age on the outcome is now well understood. Many studies have showed that children younger than 6 years of age, and even less than 4 years of age, had a better prognosis for the condition. It should be noted, however, that the prognosis of Perthes disease is likely to be poorer in children under the age of six.
The patient normally has no symptoms in the early stages of Perthes disease, and the condition can be found accidentally using x-rays taken for another reason at this time. Children have symptoms such as discomfort, limping, and trouble moving in the later stages.
Part or all of the femoral head may be affected by avascular necrosis. The femoral head collapses and loses its roundness as a result of this. Bone tissue can regenerate thanks to the body’s capacity to repair dead tissues.
The body removes the bone that has lost its vitality from the region in Perthes cases, and the process of new bone production begins. During this procedure, make sure the femoral head stays in the socket of the hip joint. The goal of Perthes disease treatment is to guarantee that the femoral head remains in its socket harmoniously while also assisting the body in cleaning and renewing dead bone tissue. By following a self-limiting procedure, the condition can be healed in around 2-5 years. Perthes disease may demand lifelong monitoring in children.
When it comes to disorders that cause limping and hip discomfort in children, a differential diagnosis should be done. Differential diagnosis is usually performed by assessing age, gender, and duration of symptoms, as well as a thorough physical examination and radiographic evaluation. Perthes disease is diagnosed using a combination of history, physical examination, and radiological imaging.
Magnetic resonance imaging, which is taken without any alterations in the X-ray, is highly beneficial in early diagnosis, especially in the early phase. In the advanced era, a hip X-ray can readily be diagnosed. A limping or in pain child should be sent to an orthopedic or traumatology specialist as immediately. Early diagnosis requires a thorough examination and evaluation by an orthopedic specialist. The course of Perthes disease is also affected by early diagnosis.
Surgical and non-surgical therapy options for Perthes disease differ depending on the stage of the illness, the degree of femoral head involvement, the child’s age, and physical examination results. Because the femoral head remodels quickly, particularly in children in the age range affected by Perthes disease, non-surgical and surgical procedures that cover the femoral head are the main treatment. The treatment’s goal is to assist the malnourished femoral head in rebuilding, ensuring that it is compatible with the hip joint socket and preventing femoral head deformity.
In the early stages of Perthes disease, it is not advisable to load the joint. Using a splint to lessen the load may be helpful depending on the stage of the condition. Crutches should be used if necessary to rest the hip during periods of higher discomfort and limping, as the illness can endure for 2-5 years. During these terrible times, children are usually not permitted to engage in sports.
It can be included to a physical therapy and rehabilitation program to help prevent or treat issues including limited mobility and loss of function. The muscles surrounding the hips are strengthened, and stresses that limit joint movement can be eased, thanks to the workouts.
If the joint becomes incompatible in the future owing to significant femoral head degradation, procedures to make the joint more compatible may be necessary. Various osteotomies are used in surgical therapy to avoid femoral head dislocation, promote joint compatibility, and keep the injured surface of the femoral head from being under pressure. In addition, arthrodiastasis and femoral head reduction procedures are performed.
Perthes disease is a hip joint disorder that affects children aged 4 to 10. In most cases, the condition is self-limiting and recovers in 2 to 5 years. Hip joint calcification may develop in the future in people with a late diagnosis and cartilage tissue injury.
If your child has moderate hip, knee, or limping discomfort, he should see an orthopedic doctor right away for a proper diagnosis and treatment.