Perthes Disease: Understanding The Causes And Symptoms Of This Hip Condition By The Best Paediatric Orthopaedic Surgeon In Bangalore | Dr. Jayanth S Sampath
Our Best Paediatric Orthopaedic Surgeon in Bangalore says Perthes’ disease is a condition where the top of the thigh bone (the femoral head) softens and breaks down. It occurs in some children and causes a limp and other symptoms.
Causes of Perthes’ disease
The cause of Perthes’ is unknown. The disease has several phases: Initially, there is a temporary loss of blood supply to the ball-shaped end of the thighbone, called the femoral head. The lost blood supply causes the ball to soften and collapse. This collapse causes the round femoral head to become flattened or deformed like a mushroom. It no longer fits perfectly in its socket. In fact, as it heals, it may even grow outside the socket. Most children with Perthes’ disease recover completely. However, it may take from two to five years to repair the damaged bone. If the femoral head is not seriously deformed, normal hip function will return. Major deformity may lead to persisting stiffness and premature arthritis of the hip.
What are the symptoms of Perthes’ disease?
Our best Paediatric Orthopaedic Surgeon in Bangalore says Symptoms tend to develop gradually
- Worse over a few weeks.
- Pain in the hip and groin area: Sometimes pain is felt just in the knee or the thigh instead of in the hip — this is called referred pain.
- Stiffness and reduced movement of the affected hip.
- In time, the affected leg may become slightly thinner (wasted) because the thigh muscles become thinner as they are not used so much as those in the other leg.
- The affected leg may look shorter than the good leg.
Treatment for Perthes’ disease
The aim of treatment is to promote the healing process and to ensure that the femoral head remains well seated in the hip socket as it heals and regrows. The choice of treatment depends on the age of the child and the severity of the condition. Treatments may include observation, bed rest, protected walking, plaster cast or surgery. Your doctor will advise on the best treatment for your child.
Observation and physiotherapy: In younger children (under 6 years old), and those with mild disease, Perthes’ disease will and can include:
- A limp: This may gradually become usually heal well without any specific treatment. These children are treated by observation with physiotherapy and home exercises. The home exercises help to keep the hip joint mobile and in a good position in the hip socket. Non-impact activities such as swimming and cycling are encouraged, to keep the hip joint active through a full range of movements. Activities that can lead to heavy impact on the hip joint such as running, jumping and contact sports are best avoided.
- Bed rest and/or crutches: This may be needed by some children for a short time if their symptoms are severe.
- Plaster casts or a special brace: Casts or braces may be considered in some cases. The aim is to keep the femoral head well positioned in the hip socket. These usually help to keep the leg slightly abducted (slightly pointing outwards). The success of brace treatment is not entirely clear, and many doctors are increasingly advising surgery for better results.
- Surgery: An operation may be considered in some cases, particularly in older children or those more severely affected. Surgery can help to keep the femoral head well positioned (Containment) whilst it heals, or can improve the shape and function of the femoral head if it has not healed well. There are various options, depending on each child’s individual situation.
Adductor tenotomy and Petrie cast
Varus femoral osteotomy (VFO): This procedure orients the femoral head deeper into the hip socket. Containment protects the femoral head from further damage and promotes quicker healing. Metal plates and screws are used to hold the femoral head in position until healing occurs. The implant is removed typically 1 year after the first surgery. VFO is the most commonly performed surgery in Perthes disease and provides superior results compared to other forms of non-surgical treatment. It is effective when performed at the correct stage of the disease and in a child less than 8 years of age.
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