Tag Archives: perthes disease

Treating Perthes Disease

Also known as Legg-Calvé-Perthes disease, Perthes disease is a childhood disorder of the hip. The disease affects the ball portion of the hip joint, known as the femoral head. Perthes is uncommon— approximately 5 to 10 children per 100,000 will be diagnosed — and it more commonly affects boys -1 in 760 boys. Here are some interesting facts about this pediatric hip disorder.

What Happens to the Hips in Perthes Disease

In a normal hip joint, the round head of your femur fits into the round socket in the pelvis. Perthes disease interrupts the blood flow to the femoral head, causing all or part of it to die due to lack of blood. The bone death is medically referred to as osteonecrosis.

Once the bone dies, the femoral head is more prone to breakage and heals poorly. As a result, the pressure and weight on the bone from normal rigorous activities can cause the round portion to become flat over few months to a year after the diagnosis. For one to two years after bone death occurs, new bone gradually begins to fill in the areas where the body has removed away the dead bone.

The Cause of Perthes Is Still Unknown

Screen Shot 2016-02-05 at 1.12.53 PMWhile we know what happens to the hip to alter the shape of the femoral head, we still don’t know what causes the precipitating interruption of blood flow. We also know that Perthes is not heritable, since less than five percent of its patients have a family history of the disease. However, some other heritable hip conditions or blood disorder can mimic Perthes, such as multiple epiphyseal dysplasia and sickle cell disease. History of taking corticosteroid for treatment of asthma, inflammatory conditions, or cancer can also produce bone necrosis that mimics Perthes.

Diagnosing Perthes Disease

Because so many other diseases can mimic the symptoms of Perthes, it is known as a disease of exclusion. Doctors will rule out other conditions by taking a careful look at medical history and performing a physical exam. The physician will typically ask about the following diseases to rule them out:

  • Family history of hip disorders or early joint replacement
  • Steroid use, such as for asthma
  • Prior hip surgeries
  • History of sickle cell disease
  • History of hip infection
  • History of endocrine or clotting disorders

To confirm a potential Perthes diagnosis, doctors will perform an X-ray of the hips. If the X-ray is taken too soon after symptoms have begun, it may appear normal. In that case, physicians can order a very sensitive diagnostic test called perfusion MRI if they still suspect Perthes.

Treatments and Complications

The body will naturally remove and replace the dead bone of the femoral head with new bone, so, to some extent, Perthes heals itself. However, the healing process may be slow and even after healing has taken place, the femoral head may not return to its original round shape. When that fails to happen, patients may experience long-term complications, such as pain, stiffness and a greater risk of arthritis later in life.

Screen Shot 2016-02-05 at 1.24.29 PMUntil the healing phase is complete, non-surgical treatments might include crutches, wheelchairs, casting and/or bracing, and reduced physical activity. Surgical treatments might include pelvic or femoral osteotomy, a process that reshapes the pelvis or femur.

While Perthes is in some ways self-healing, femoral heads sometimes don’t heal properly. With the interventions we have today and new treatment knowledge about the condition, those with Perthes can usually return to daily activities and sports activities without problems.

For more information about Perthes Disease and becoming a patient at TSRHC, visit the hip disorders section on our website.

TSRHC Leads the Charge on Perthes Disease Research

While TSRHC is known across the globe for its excellence in pediatric orthopaedics, it is also recognized for groundbreaking research. The studies TSRHC staff participate in allow physicians worldwide to better understand various orthopaedic conditions.

One particular research study focuses on Legg-Calve-Perthes Disease (LCPD), a condition that affects the femoral head or the “ball” part of the hip joint. In Perthes Disease, the blood supply to the femoral head is disrupted and all or part of the femoral head dies from the lack of blood flow.

A History of Research

Twenty years ago, Tony Herring, M.D., started a large, prospective multi-center study with the purpose of understanding the outcomes of pediatric patients with Perthes Disease. Participating institutions treated patients with five different methods: non-surgical treatment, which included bracing and physical therapy; surgical treatment, which included femoral or pelvic osteotomy; and observation. Herring and his colleagues published their findings in the 2004 Journal of Bone and Joint Surgery.

Herring, along with Dan Sucato, M.D., M.S., led the efforts to invite the patients from the study who were treated non-operatively back to TSRHC for a clinical, radiographic and functional evaluation.

“The results of this study gave us the unique opportunity to review the long-term outcomes of patients who were treated with non-operative intervention. We found that the majority of these patients complained of increasing pain and dysfunction. This was the first study to document these findings at 20-year follow-up,” said Sucato. These results were published last year in The Journal of Bone and Joint Surgery.

Sucato was recently awarded the Angela Kuo Memorial Award, a $30,000 grant, from the Pediatric Orthopaedic Society of North America (POSNA) at the 2013 POSNA Annual Meeting. This grant will be used to fund the third part of this study, which will review the clinical, functional and radiographic outcomes of patients originally treated with surgery. At this time, 18 patients from across the nation have participated in the follow-up study.

Follow-up Study for the Future

One of these patients, Jaclyn Davidson, age 30, recently visited TSRHC for an evaluation with Sucato and Harry Kim, M.D., M.S. Davidson was originally treated with pelvic surgery when she was 7 years old.

“Having the opportunity to evaluate patients like Ms. Davidson after 20 years of follow-up allows us to keep learning about the long-term effects of treatment patterns for Perthes Disease. We are grateful for their time and efforts. The results of this data will help us improve treatments for our current patients with Perthes Disease,” Sucato noted.

As the study moves forward, TSRHC staff will continue to learn more about the condition and how to better treat patients who are affected by it.

To learn more about the disease and the multicenter study research for current patients with Perthes Disease happening at TSRHC, please visit: www.perthesdisease.org.