Perthes' disease: Information & Perthes' disease specialists

Perthes' disease is also known as Perthes' disease or juvenile femoral head necrosis. It is a circulatory disorder of the femoral head during growth. The causes have not yet been conclusively clarified. You can find further information and selected Perthes' disease specialists and centers here.

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Brief overview:

What is Perthes' disease? A circulatory disorder of the femoral head during growth, which causes the bone tissue of the femoral head to die off, but at the same time to regenerate.
Who is affected? It is more common in boys between the ages of four and nine. The disease lasts between two and four years.
Symptoms: Severe symptoms do not always occur. Stress-related complaints in the groin, thigh and sometimes the knee joint are more common. Movement of the hip joint is often restricted.
Diagnosis: In the early stages, only an MRI can show the changes in the bone tissue. Later, an X-ray examination is the preferred form of diagnosis.
Stages: Doctors divide the disease into five different stages. The classification is based on the progression of the disease.
Treatment: Children must avoid exertion for the duration of the disease, i.e. little walking and, above all, no playing soccer or jumping. Swimming and cycling, on the other hand, are encouraged. This allows the joint to develop well despite the disease.
Follow-up treatment: Daily physiotherapy helps to achieve good joint mobility and therefore good healing. Medication or surgery may also be indicated.
Prognosis: The prognosis depends on how the hip socket and acetabulum develop. If the disease causes significant deformities, this can lead to early osteoarthritis, which may necessitate the use of an artificial hip joint in early years.

What happens with Perthes' disease?

Perthes' disease refers to a circulatory disorder of the femoral head during the growth phase. This initially leads to the death of the bone tissue (osteonecrosis) of the femoral head. The dead tissue is broken down by the body. At the same time, repair processes take place with renewed bone formation.

The disease mainly affects boys between the ages of 4 and 9. The disease progresses over a period of approx. 2 to 4 years, occasionally longer if the disease starts later.

What are the symptoms of Perthes' disease?

The disease is often asymptomatic. Occasionally, at the beginning, there are complaints in the area of the groin and thigh that are dependent on exertion. Sometimes children also report pain in the knee joint. Occasionally, parents observe a limp.

In many cases, the clinical examination reveals a considerable restriction of movement in the hip joint.

Aufbau des Beckens
The structure of the human pelvis and hip joint © Henrie | AdobeStock

How is Perthes' disease diagnosed?

The diagnosis is made by X-ray.

In the early stages, in some cases no change can be seen on the X-ray if symptoms are already present. In the very early stages, the diagnosis must therefore be made using magnetic resonance imaging(MRI). Otherwise, MRI does not provide the information required to determine the therapy.

The disease shows a staged progression, which can be traced in the X-ray image.

The stages of Perthes' disease

Initial stage: the joint space is relatively widened compared to the healthy opposite side.
Condensation stage: the bone of the femoral head appears compacted and decreases in height.
Fragmentation stage: The femoral head appears fragmented on the X-ray. In this stage, resorption of dead tissue and reconstruction of the femoral head take place simultaneously. There is often a change in the anatomical shape with a widening of the femoral head and neck. In some cases, there is a tendency for the head to subluxate out of the acetabulum. The femoral head is then no longer completely covered by the acetabulum.
Repair stage: The repair processes of the organism can be recognized and the femoral head remodels itself.
Final stage: The femoral head has developed its final shape. The appearance of the head in relation to the acetabulum determines the long-term prognosis.

Treatment of Perthes' disease

The aim of all therapeutic measures is to restore the joint to as normal a state as possible. This means that it should

a spherical femoral head and
good congruence between the acetabulum and femoral head (containment) and
good function

function. Depending on the course and severity of the disease, different measures are required to achieve this goal.

As a general rule, weight-bearing should be reduced during the florid phase of the disease. The motto is "save steps". Jumping and impact loads should be avoided at all costs (e.g. playing soccer, jumping).

Non-weight-bearing activities such as swimming and cycling should be encouraged.

Follow-up treatment for Perthes' disease

Good joint mobility is an essential prerequisite for a good healing result. This requires regular physiotherapy exercises with reduced joint mobility. The patient must also perform these exercises daily at home under supervision.

In some cases with very pronounced restriction of movement, intensive inpatient treatment is advisable. In this case, extension treatment is also used to loosen the soft tissue and stretch the muscles. Treatment with muscle-relaxing and pain-relieving medication is also used.

In rare cases, we recommend the injection of botulinum toxin after a detailed consultation. This is a medication that reduces the tension in the muscles. It improves mobility.

Sometimes regular X-ray checks reveal that the femoral head is not well centered in the acetabulum. Surgical measures may then be necessary to improve the congruence between the femoral head and the acetabulum. These are performed either

on the femur (varus osteotomy) and/or
on the pelvis with correction of the acetabular cup position (Salter surgery, triple osteotomy)

are performed.

If an operation had to be performed, it is still extremely important to maintain mobility in the postoperative phase. For this reason, physiotherapy should be continued on an ongoing basis.

The affected leg must be relieved of weight until the bone has completely healed. This takes around 6 to 10 weeks and is monitored using X-ray images. Fixation in a plaster cast should only be used in exceptional cases (insecure fixation of the osteotomy, uncooperative child).

Perthes' disease and medication

To date, no medication is known to have a positive effect on the circulatory disorder in Perthes' disease. Anti-inflammatory and pain-relieving medication is indicated if the young patient complains of discomfort.

Muscle relaxant medication can be used to reduce muscle tone. This facilitates physiotherapeutic exercise treatment and promotes the goal of improving mobility.

What is the prognosis for Perthes' disease?

The long-term prognosis for Perthes' disease depends on the congruence between the femoral head and the acetabulum. If the healing process is successful and congruence between the femoral head and the acetabulum has been restored, the prognosis is good.

In cases where considerable deformation of the hip joint has occurred, premature signs of wear and tear(osteoarthritis) can occur. This can then make joint replacement surgery(implantation of a total hip endoprosthesis) necessary at an early age.

Are there preventive measures for Perthes' disease?

Perthes' disease is a fatal disease that cannot be avoided by preventive measures.

Questions about Perthes' disease

Can Perthes' disease also occur in the other hip joint? Yes, this is generally possible. The probability of bilateral occurrence is 5 to 15 percent.
Is the disease hereditary? Genetic studies suggest a hereditary component: first-degree relatives of Perthes disease sufferers are 35 times more likely to develop Perthes disease.
Does a diagnosis of Perthes' disease always require surgery? No - the need for surgery depends on the position of the femoral head in relation to the acetabulum. In some cases, a good healing result can also be achieved with exclusively conservative treatment.