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Paediatric Orthopaedics

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Perthes' disease

What is Perthes' disease?

Perthes' disease is a condition affecting the hip joint in children. It is rare (1 in 9,000 children are affected) and we do not clearly understand why it occurs.

Part or all of the femoral head (top of the thigh bone: the ball part of the ball-and-socket hip joint) loses its blood supply and may become misshapen. This may lead to arthritis of the hip in later years.

What are the symptoms?

Children with Perthes' disease usually complain of pain in the groin, the thigh or the knee - particularly after physical activity. They limp and have a restricted range of movement (stiffness) of the hip joint. These symptoms may persist on and off for many months. The disease itself lasts for a few years.

What treatment is required?

About 60 percent of children with Perthes' disease recover without any treatment. It is important, however, for all children to be carefully followed up by their doctor during the course of the disease. They usually have to attend clinic every 3-4 months for examination and X-rays. In that way, children that are at risk of doing less well are identified and treated accordingly.

Treatment for Perthes' disease depends on the severity of the disease and may include physiotherapy, crutches, plasters or, sometimes, an operation to re-shape the bone around the hip joint.

Parents may be asked to try to limit their child's physical activities and particularly contact sports when the disease is active. When considering treatment, the doctor may often recommend a procedure called an arthrogram. This involves injecting dye that shows-up on X-ray into the hip joint under an anaesthetic. X-rays are then taken with the dye in the joint and these help us to decide if an operation would help.

What are the long-term effects of Perthes' disease?

These depend on how severely the shape of the hip joint is altered by the disease. Some patients will end up with painful arthritis at some stage in adult life and may require a hip replacement.

In a small number of severely affected children, the symptoms of pain and stiffness persist for years even though the disease is no longer active. These children may require additional operations in childhood.

More than half of the children with Perthes' disease return to normal activities within a few years from the beginning of the disease.