Perthes’ disease
Perthes' disease is a childhood condition affecting the hip.
Perthes’ disease is rare, affecting 1 in 9,000 children, and we do not fully understand the reason why it occurs.
Perthes’ disease affects the femoral head – the ball part of the ball-and-socket hip joint at the top of the thigh bone. It loses its blood supply and as a result can become misshapen. This can lead to arthritis of the hip in later years.
If your child is limping and develops any of the following signs you should urgently call 111 who will triage if your child needs urgent care:
- Sudden onset pain in their hip, thigh or knee
- Unable to put any weight on their leg to stand or walk
- The leg has changed shape or is pointing at an odd angle
- Generally unwell with a high temperature, feeling hot and shivery
- Severe pain in the lower part of their tummy
- Symptoms are getting worse
Symptoms
Long-term effects
Treatment
Symptoms
Children with Perthes’ disease usually complain of pain in the groin, thigh or the knee – particularly after being active.
They also can limp and have a stiffness of the hip joint. These symptoms may persist on and off for many months. The disease itself lasts for a few years.
Long-term effects
Over time, the blood supply to the head of the femur returns and the bone begins to grow back.
Treatment for Perthes’ focuses on helping the bone grow back into a more rounded shape that still fits into the socket of the hip joint. This will help the hip joint move normally and prevent hip problems in adulthood.
Long-term effects 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number of severely affected children, the symptoms of pain and stiffness persist for years even though the disease is no longer active.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.
Treatment
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 an orthopaedic service at regular intervals through the course of the disease. The child will have to attend clinic every few months for examination and X-rays. This is so that we can monitor progress and identify and treat those that are doing less well.
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.
Physiotherapy exercises include activities and exercises to promote range of movement around the hip joint, strengthen muscles and educate families and caregivers regarding the nature of the condition and signpost to activities that can help.
If you have any concerns or queries about your child’s recovery please contact Dolphin Outpatients on 02921 847577.
If you child does not have an appointment arranged with physio and symptoms continue or are not improving gradually, then you can self-refer your child to the Paediatric physiotherapy outpatient department by telephoning our referral line on 02921836908.
