Perthes’ Disease / Legg-Calvé-Perthes’ Disease (LCPD)

Perthes’ disease is an important differential diagnosis of a limping child.

A limp in a child may be due to a minor cause, but the serious differentials has to be exclude to arrive at a proper diagnosis.

Differential diagnosis of a limping child includes….

Perthe’s disease is a condition affecting the hip joint in children which occur due compromised blood supply to the femoral head leading to avascular necrosis of the femoral epiphysis of the femoral head.

Incidence : Rare condition, 4 of 100 000 children develops this condition

Prognosis of Perthes’ Disease is good. A very small proportion may develop osteoarthritis of the hip join in adult life.

Aetiology Of Perthes’ Disease

Exact cause is unknown
May occur following….

  • Trauma
  • Corticosteroid use
  • Sickle cell anaemia
  • Developmental dysplasia of the hip 

Pathophysiology Of Perthes’ Disease

Idiopathic interruption of the blood supply to the femoral head
Bone infarction — Avascular necrosis
Reduced range of motion of the hop joint
Increased risk of fracture
New blood vessels formation
Ossification begins to occur
Bone remodeling takes place 
Normally functioning hip joint (Only in some cases)

 Clinical Presentation Of Perthes’ Disease

  • Commonly affects children at 4 10 years old age
  • Males : Female ratio is 4 : 1
  • Mostly unilateral, but 20% of cases are bilateral 
  • Limping gait – Specially after exertion 
    • Hip abduction is more affected than other movements
  • Pain in hip joint, sometimes referred to the knee and thigh
  • Pain worsens with activity
    • Pain begins to occur with the onset of necrosis of the femoral head
  • Ultimately the child develops an antalgic gait with reduced hip movements 
  • These symptoms have “on and off” periods 

Investigations Of Perthes’ Disease

  • Plain X-Ray – Diagnostic 
    • AP view of the hip join
    • Frog-leg lateral view of the pelvis
  • These investigations are done only in some occasions 
    • Technetium bone scan 
    • MRI 

Staging Of Perthe’s Disease

Catterall Staging

  • Stage 1 – Clinical and histological features only 
  • Stage 2 – Sclerosis with / without cystic changes and preservation of articular surface
  • Stage 3 – Loss of structural integrity of the femoral head
  • Stage 4 – Loss of acetabular integrity 

Radiological staging

  • Stage 1 – Cessation of femoral epiphyseal growth 
  • Stage 2 – Subchondral fracture 
  • Stage 3 – Resorption 
  • Stage 4 – Reossification 
  • Stage 5 – Healed or residual stage

Management Of Perthes’ Disease

60% of cases heal with only conservative management
But the patient has to be followed up in the clinic every 4 monthly, till the patient is completely healed
Disease process may persist for years with “on and off” periods

Conservative management

  • Minimize weight bearing on the hip joint – To avoid injury and to promote regeneration 
    • Rest
    • Clutches 
    • Braces 
  • Analgesics
  • Physiotherapy

Surgical management
  • Done in patients with fracture of femoral head
  • Osteotomy is performed 
  • Surgical intervention has proved to have a better outcome than non surgical techniques 
  • But the rate of recovery is the same 

Complications Of Perthes’ Disease

  • During conservative management, some cases fail to achieve the spherical shape of the femoral head
    This leads to reduced range of motion of the hip joint
  • Surgery may result in a chronic limp



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