Perthes Disease

Question 1

Perthes disease AKA

Answer 1

Avascular necrosis of the femoral head

Question 2

Perthes disease is characterised by…

Answer 2

Collapse and then healing and reconstitution of the femoral head over a period of 2 to 4 years

Question 3

What age does Perthes disease typically affect?

Answer 3

Children aged 4 to 8 years

Question 4

What % of Perthes disease is bilateral

Answer 4

Bilateral in 10 to 15% of patients

Question 5

Is Perthes disease more common in males or females?

Answer 5

Males

Question 6

Does Perthes disease follow a predictable course?

Answer 6

Every case of Perthes disease is different. No two children will follow an identical course.

Question 7

Typical pain on history suggestive of Perthes disease

Answer 7

Pain in the knee, thigh, groin, or hip when the child puts weight on the affected side.

Question 8

Do patients with Perthes disease limp?

Answer 8

Occasional limp early in the illness
Episodic limping and pain getting worse as time goes by

Question 9

Examination findings suggestive of Perthes disease

Answer 9

May be reduced movement of the hip joint (stiffness)

If the child has had the condition for a long time, the leg on the affected side may become shorter.

Question 10

Recommended investigations in Perthes disease

Answer 10

Arrange an AP hip and frog leg lateral X-ray if Perthes disease is suspected

Question 10

When to refer to ortho?

Answer 10

If xray confirms Perthes

Question 10

What is the aim of treatment in Perthes disease?

Answer 10

Treatment aimed at minimising the deformity of the femoral head during the natural progression of the disease. The more spherical the femoral head is after the Perthes disease has healed, the better the long term outcome.

Question 10

What treatment can ortho offer?

Answer 10

Specialist management is age and severity related. Can range from activity restriction to surgery.

Question 10

General management while awaiting ortho review

Answer 10

Education re natural history - may involve treatment and activity restriction over several years
Stop competitive and impacting sports until adequate healing has occurred.
Paracetamol + NSAIDs for analgesia
Consider physiotherapy

Question 11

Role of physio in management

Answer 11

Advice on appropriate stretching, strengthening exercises, gait re-education, and suitable activities

Question 12

Explain Perthes disease in simple language

Answer 12

A problem that changes the shape of the top of the thighbone. The bone doesn’t fit into the hip joint normally, causing pain and limping.

Not enough blood reaches the ball of the hip. As a result bone cells in the ball of the hip starve and die. The body starts to break down the ball of the hip.
After a few months, the body starts to rebuild the bone.