Perthes Disease

• Perthes Disease (Legg-Calve-Perthe’s)

  • Idiopathic avascular necrosis of the femoral head in young patients due to temporary blood loss at the femoral head
• Perthes Disease - Potential causes

  • Linked to smoking during pregnancy
  • Repeated or single episode of ischemia
  • Repetitive microtrauma
• Perthes Disease - Who is at risk?

  • Children aged 4 - 9 years old
  • Boys > girls 4:1
• Perthes Disease - Symptoms

  • Dull ache in hip/groin region
  • Usually unilateral pain
  • Pain typically worse during physical activity
  • Diurnal pattern: Worse later in the day and night
• Perthes Disease - Objective findings

  • Altered gait: Trendelenburg
  • Restricted hip ROM and FABERS test
  • Adduction tightness
  • Glute and abductor atrophy
• Perthes Disease - Prognosis

  • The 4 stages can be self limiting and may require surgery
  • Recovery approximately 3 - 5 + years
  • Better outcome for ages younger than 6, due to better remodelling chances
  • 80% hips have a good outcome into early 40
  • Over 50% most likely to develop severe OA and require a hip replacement
• Perthes Disease - Imaging

  • X-ray can determine the prognosis via identifying the stages
• Perthes Disease - Management aims

  • Painfree ROM
  • Global hip strengthening (abductors, extensors)
  • Gait retraining
  • Balance retraining
  • Orthosis to maintain hip congruency