A childhood hip condition in which the blood supply to the femoral head is temporarily disrupted. Early assessment and appropriate management are important in optimising long-term outcomes.
(03) 9573 9659
Perthes disease is a childhood hip condition in which the blood supply to the femoral head is temporarily disrupted, causing the bone to soften, collapse and then slowly reform. Early assessment and appropriate management during the healing phase are important in minimising the risk of long-term deformity and giving the best possible outcome.
Without adequate blood supply, the femoral head loses structural integrity and can collapse under normal loading. Over time the bone repairs itself through a process of resorption and new bone formation, but the final shape of the femoral head depends on the severity of the initial collapse, the age of the child and the quality of the remodelling process.
The condition progresses through four stages: avascular necrosis, fragmentation, re-ossification and remodelling. The total process typically takes two to four years.
Perthes disease is approximately four times more common in boys than girls, and most commonly presents between the ages of 4 and 10. Bilateral involvement affects around 10 to 15 per cent of cases. The cause is not fully understood, though genetic and environmental factors are thought to play a role.
Children typically present with a limp, often without a clear history of injury. There may be pain in the hip, groin or knee. Knee pain is a common presentation and can lead to delayed diagnosis if the hip is not examined. Reduced range of hip movement and a reluctance to participate in physical activity are also commonly seen.
Diagnosis is confirmed with X-rays, which show the characteristic changes at each stage of the condition. MRI may be used in early cases when X-ray changes are not yet apparent, or to assess the extent of femoral head involvement more precisely.
The primary goal of treatment is to maintain containment of the femoral head within the acetabulum during the healing phase, which reduces the risk of permanent deformity. Treatment depends on the age of the child at diagnosis, the degree of femoral head involvement and whether the femoral head is well contained within the socket.
Non-surgical options include physiotherapy, activity modification, bracing and traction. In some patients, particularly those with significant femoral head involvement or poor containment, surgical containment using a femoral or pelvic osteotomy is recommended to improve the long-term result.
Mr Balakumar reviews each case carefully, discusses the options with the family and makes recommendations based on the individual clinical and radiological picture. He has extensive experience in managing Perthes disease at the Royal Children’s Hospital Melbourne and in the private setting.
(03) 9573 9659
Mr Balakumar is one of a small number of surgeons in Australia with formal training in both paediatric and adult hip surgery. His fellowship at Harvard’s Children’s Hospital in Boston, under some of the world’s leading specialists in hip preservation, gives him a depth of expertise that is difficult to find in a single practice.
His approach is the same whether the patient is 6 months or 65 years old – thorough assessment, honest options, and no pressure toward surgery until the clinical picture clearly supports it.
(03) 9573 9659
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