Perthes Disease

Perthe's disease is condition that occurs as a result of a temporary loss of blood supply to the hip. Despite huge advances in research in Perthes there is very little consensus on Perthes treatments and natural history. Dr Balakumar is a specialist in treating active and residual Perthes.

The loss of blood supply results in the rounded head of the femur collapsing. The area becomes inflamed and irritated.  Perthes is really a complex process of stages. Treatment of Perthes requires periods of immobilization and decreased activities . The long term prognosis varies depending on the age of presentation and sex.

Most Perthes settles down after 18 months to 2 years.  It is usually seen in children between the ages of 4 years and 10 years of age. It is five times more common in boys than girls. It was initially described as form of childhood arthritis of the hips.

Symptoms

Limp is the main presenting symptom. Most children with Perthes will not complain of severe pain. After the diagnosis is made and the child is restricted from activities, the child is even less likely to complain of pain. They are aware that this may result in further cessation of activities. Therefore limp is one of the best indicators of a sick hip.

Diagnosis

This is usually done by plain X-Ray and sometimes MRI. The child with Perthes will be observed with serial X-Rays.

Treatment

This is controversial in Perthes in childhood. In adult residual Perthes, the treatment is easier, with treatment aimed at improving joint mechanics and if not replacing the joint.

In childhood, Perthes treatment is based on three principles

1. Keep the child painfree
2. Maintain abduction(sideways movement)
3. Contain the femoral head (keep the ball within the socket)

This depends on age, prognosis (what is the expected outcome), sex, examination and movement.

The types of treatment in Perthes includes:

1. Activity restriction
2. NSAIDs (anti-inflammatories)
3. Broomstick plasters
4. Slings and Springs
5. Arthroscopy and Steroid
6. Bisphosphanate drugs
7. Femoral Osteotomy
8. Acetabular Osteotomy

All of these are available treatments for Perthes. Most often Dr Balakumar will try and manage your child non-operatively. However if he predicts that there are some head at risk signs on the X-Rays or the hip is behaving badly, then he may recommend early intervention.

Despite the outcome from Perthes, most people who have had Perthes will do well as adults.