Perthes' Disease

Question 1

What is Perthes’?

Answer 1

Legg-Calvé-Perthes (LCP) disease is a childhood hip disorder initiated by idiopathic avascular necrosis of capital femoral epiphysis

Question 2

Epidemiology:

• age
• M/F?

Answer 2

• Peak incidence is between 5 - 7 years of age, occurs b/n 3-12 yo
• M > F (4:1)

Question 3

Risk factors for Perthes’

Answer 3

• FHx
• Low birth weight
• Abnormal pregnancy/delivery
• History of trauma to affected hip

Question 4

Clinical features for Perthes’

Answer 4

• Patients present with limp of insidious onset and a Trendelenburg gait
• Pain is absent or mild and often referred to the anteromedial thigh or knee
• Limited internal rotation and abduction of the hip
• Atrophy of the thighs and buttocks
• Shortening of affected leg

Question 5

What is the diagnostic sign on imaging for Perthes’?

Answer 5

XR: characteristic collapse of femoral head (may be negative early)

Question 6

Mx of Perthes’

Answer 6

• Refer to paediatric orthopod

• Conservative
  
  • NWB
  • Physiotherapy
  • Splinting/braces in flexion and abduction
  • Restriction of high impact sports and running - swimming encouraged

• Surgery - e.g. femoral or pelvic osteotomy
50% of involved hips do well with non-operative treatment