Perthes Disease

What is Perthes Disease?

Legg-Calve-Perthes disease is a condition that affects the top of the thighbone (femur) and the hip joint. At the ends of the bones are the growth plates (epiphyses) and these need a blood supply in order to maintain growth, especially in childhood and adolescence.

In Perthes, the blood supply to the end of the thighbone is affected, causing the bone at the growth plate to gradually soften and break down. As the blood supply returns to the bone, it begins to reform. However as the bone redevelopments, the round end (head) of the femur that fits into the round hip joint socket can become flattened.

Symptoms of Perthes

• Pain – the pain is persistent and usually occurs in the hip or groin area but it may also come from the knee.
• Limp – The affected bone may cause a limp when walking
• Muscle wasting – This will be most noticeable at the top end of the thigh
• Leg shortening – The affected leg may appear to become shorter than the other leg
• Stiffness – Due to the altered shape of the femur, movement may be reduced in the hip.

Who gets Perthes?

• The cause of Perthes is still unknown but it can present at any time from the age of three up until the early teenage years. The most common age range is from three to eight years of age.
• Boys are more likely to be effected than girls in a ratio of about four to one
• In 10-20% of patients, both hips are affected.

How is Perthes diagnosed?

Usually a thorough examination of the joint along with an x-ray is enough to diagnose Perthes. In some cases, diagnosis may need an investigation called an arthrogram.

This involves injecting dye into the joint space of the hip whilst x-rays are taken.

What treatments are available?

At present the aim of treatment is to maintain a good full range of movement in the affected hip joint, minimise any future deformity of the head of the thighbone and to control any pain.

Most children do not require surgery. Treatment usually consists of physiotherapy, hydrotherapy and most importantly personal home exercises.

Surgery

• In a small number of patients, surgery will be recommended.
• Early on in the disease, surgery may be used to reduce the effects of the condition.
• Some cases benefit from an operation to try to improve the range of movement in the joint.
• Some older children (over eight years of age) may be offered an operation to allow more space in the hip joint.

Your surgeon will discuss all of the options with you and provide further information.

Timescales and outcome

The condition takes at least two years to run its course, during which time the level and nature of stiffness and discomfort will change. The final outcome is also very variable with some children returning to normal while others have permanent stiffness and an altered way of walking.

Limitations

Patients with Perthes disease are usually quite active people. However they may be asked to avoid contact sports (rugby, football etc) as well as impact activities such as jumping.

Crutches may be required at some stage.

Some activities are good such as swimming or cycling (for up to one hour a day).

Who to contact

Local contacts
Joanna Easton, medical secretary, 0191 233 6161 (between 9am and 5pm)
Julie Alan and Sharon Solan, Physiotherapists, 0191 2448221 (between 9am and 5pm)
Ward 17 Freeman Hospital, 0191 213 7017 (direct line) (anytime)

National contacts
The Perthes Association was founded in Birmingham in 1976.
Address: PO Box 773 Helpline: 01483 306637
Guildford GU1 1XN Website: www.perthes.org.uk 

Parents of Perthes Support Group – based in Hull which aims to provide a wider awareness of Perthes throughout the UK
Address: 6 Ash Close Tel: 01482 814721
Sproatley E-mail: parentsofperthes@hull24.com
East Yorkshire HU11 4XE sheila@audi44.freeserve.co.uk
Website: www.audit44.freeserve.co,uk 

Please note that many web pages originate in America and therefore may mention treatments that are no longer recommended in the UK.