Treatments for Perthes’ disease aim to maintain the optimum local environment in and around the hip joint for self-healing to occur with minimal deformity of the femoral head. 9, 10 Traditionally, non-surgical treatment options include orthotic management (e.g. braces and callipers), physical interventions such as strengthening and stretching regimes, walking aids, activity modification, or watchful waiting. 11, 12 In recent decades, surgery has also often been considered. 7 In the absence of clinical guidelines, there is currently no standardized approach to treatment selection.
Full Answer
What is the treatment for Perthes disease?
Perthes disease is a rare childhood condition affecting the hip joint. Bone in the “ball” (femur head) part of the “ball and socket” hip joint dies from lack of blood supply. When the blood supply returns, a new femoral head forms. Treatments include time/observation, drugs, physical therapy, casting and surgery.
What are the stages of evolution of Perthes disease?
The stages of evolution of Perthes’ disease. The early part of the disease is from the onset till Stage IIa (early fragmentation stage). The late part of the disease is from Stage IIb to Stage IIIb. Intervention aimed at preventing femoral head deformation is only feasible during the early part of the disease
What is the main complication of Perthes disease?
The main complication of Perthes’ disease is femoral head deformation. Evidence from the literature highlights two important factors related to the cause and timing of this complication. (1) Extrusion of the femoral head appears to be a major factor that leads to femoral head deformation.
What increases my child's risk of Perthes disease?
There is a much lower incidence rate in Native Americans, people with African heritage, Polynesians, Blacks and in Australian aboriginals. Exposure to secondhand smoke may also increase your child's risk of Perthes disease, although the exact reasons why are not known. Symptoms and Causes What are the causes of Perthes diseases?
Is there a cure for Perthes disease?
Most children with Perthes' disease eventually recover, but it can take anywhere from two to five years for the femoral head to regrow and return to normal, or close to normal. Perthes' disease is also known as Legg-Calve-Perthes disease or coxa plana.
What surgical techniques are used to treat Perthes disease?
Femoral varus osteotomy has become one of the most popular surgical techniques for Perthes disease, since the first report by Axer in 1965 [38,88]. The aim of this method is to center the femoral head deeply within the acetabulum and allow correction of the flexion or rotational deformity simultaneously [10].
Which is a better method for Perthes disease femoral varus or Salter osteotomy?
We think that the Salter innominate osteotomy is the better treatment for patients with Perthes' disease to decrease residual problems such as coxa vara, trochanteric prominence, poor acetabular coverage, and the surgical scar.
Does Perthes need surgery?
If diagnosed with Perthes in the first few months, the majority of patients can be treated with anti-inflammatories and physical therapy, Tis has found. But 1 in 10 children with early Perthes will have a large loss of blood flow and require surgery.
What is a Salter osteotomy?
What Is a Salter Pelvic Osteotomy? This is a surgery to help correct a hip socket that is too shallow or has a different shape. A surgeon makes a cut on the outside of the hip and realigns the pelvic bone so that the socket can cover the ball of the hip joint better.
What happens if Perthes disease is not treated?
Are there complications of Legg-Calve-Perthes disease? Yes. The head of the femur may lose its normal spherical shape and/or collapse. Also, degenerative joint disease can occur (i.e., as occurs in osteoarthritis).
What is a Pemberton osteotomy?
Pemberton osteotomy is the treatment of choice for bilateral, moderate to severe hip dysplasia in children under 6 years old. In this procedure, the acetabulum is rotated down through the triradiate cartilage to change the direction and increase the depth of the socket.
What is a osteotomy procedure?
Osteotomy literally means "cutting of the bone." In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on one compartment of the knee joint.
Is Perthes self limiting?
Perthes' disease is a self-limiting disease of children characterized by interruption of the blood supply to the capital femoral epiphysis resulting in necrosis of the epiphysis.
Is Perthes genetic?
Legg-Calvé-Perthes disease is usually not caused by genetic factors. The cause in these cases is unknown. In a small percentage of cases, mutations in the COL2A1 gene cause the bone abnormalities characteristic of Legg-Calvé-Perthes disease.
Can you walk with Perthes disease?
Some children may need to walk with crutches or be prescribed bed rest during the treatment process. If the disease continues to progress, the next step may be to place the child in a cast to keep the hips in the best position for healing.
How long does it take for Perthes disease to respond to treatment?
Fortunately, Perthes disease can respond well to treatment. In most cases, after two to five years of treatment/observation, many children can return to their normal activities without limitations. Children who develop Perthes disease who are six years old or younger have an excellent prognosis with observation alone.
How old is Perthes disease?
Perthes disease usually affects children between the ages of four and eight years, but the range can extend to between two and 12 years old. Both hips are affected in up to 15% of children.
What happens when the head of the femur collapses?
First, bone cells in the head of the femur die. Next, weakness in this area causes the head of the femur to eventually collapse (usually occurs over a two-year period), and lose its roundness – this is called “fragmentation.”. The damaged bone tissue is then absorbed by the body.
Why does the ball of the femur die?
Technically, the ball of the femur dies because the blood supply to it is temporally cut off. The reason (s) why this happens are not well understood. There is some evidence that genetics may play a role, but more study is needed. The lack of a steady blood supply to the ball of the femur causes a sequence of events.
Does secondhand smoke cause Perthes disease?
There is a much lower incidence rate in Native Americans, people with African heritage, Polynesians, Blacks and in Australian aboriginals. Exposure to secondhand smoke may also increase your child's risk of Perthes disease, although the exact reasons why are not known.
Is Perthes disease more common in boys than girls?
Perthes disease is five times more common in boys than in girls. Perthes disease often affects children who are very active, even athletic. Children tend to be smaller than average for their age. The disease is also more common in Asians, Eskimos and Caucasians.
Does the femur heal into a round head?
Lastly, the bone heals into its final shape, though this final shape is not always a perfect, round head. How well the head of the femur heals into a rounded shape depends on the extent of the bone collapse and how old your child is at the time that the disease process started.
How to treat Perthes in kids?
Some kids will have milder cases of Perthes that can be treated with activity restrictions, physical therapy and anti-inflammatory medication. Temporary bed rest or decreased weight bearing with a wheelchair or crutches can also be used to decrease the pressure on the hip and the hip joint irritation.
What age can you swim with Perthes disease?
UNDER AGE 6. Most children who are diagnosed with Perthes disease before the age of 6 have a favorable long term outcome regardless of the treatment. Most doctors recommend some activity restrictions, avoiding impact activities like running and jumping, while still allowing biking and swimming.
How long does it take for an external fixator to adjust?
The external fixator may have hinges to allow some hip movement or may be solid not allowing movement. The external fixator is gradually adjusted until the hip is in the best position possible. The hip is then left in this “best fit” position for about 4 months to allow for healing.
What is the procedure for cutting the bone around the hip called?
Surgical treatment involves cutting one of the bones around the hip, and is called an osteotomy . A femoral osteotomy (shown below) means the cut is in the thigh bone (also called femur) and a pelvic osteotomy means the cut is in the socket bone above the hip.
How long do you wear a Petrie cast?
These Petrie casts are commonly worn for 6 weeks and then followed with a brace called A-frame that keeps the legs spread apart but allows kids to walk with assistance. Unfortunately, many kids in this age group have more severe involvement and benefit from more extensive surgery.
What is the procedure to fix a stiff hip?
In more moderate cases with a very stiff hip, soft tissue surgery to increase hip joint mobility and casting to rest the hip are recommended. The surgery may involve injecting dye into the hip joint and then moving the hip while looking at it with an x-ray machine (called hip arthrogram).
When to remove screws and plates from hip?
The plates and screws are routinely removed once the hip is healed. AGES 8 AND OLDER. Kids diagnosed with Perthes after age 8 have the most guarded long term outlook. The natural history, or what would happen if nothing is done, is generally poor unless the disease is mild. Therefore surgery is frequently recommended.
