What are the symptoms of Perthes' disease?
The symptoms usually develop gradually over a period of time. The first indication that a child may have Perthes' disease is when they develop a limp. The affected hip is often but not always painful. The symptoms may include:
The affected hip is often painful and pain is also felt in the groin. The pain is also often felt in the thigh and the knee. This is not because the knee is affected but because hip pain is often felt in the knee. This is called referred pain.
The leg of the affected hip may become shortened compared with the unaffected side.
Children with Perthes' disease often develop a limp, which becomes gradually worse over a few weeks.
Stiffness and a reduced range of movement
As the hip becomes more damaged, the affected hip becomes stiff and the range of movements of the hip decreases.
Because the affected leg can't be used normally, the leg's muscles will become weaker. This causes the thigh muscles on the affected side to become wasted and so the leg looks thinner when you compare it with the other leg. This may not be obvious when both hips are affected.
Do the symptoms get better?
In many cases, the top of the thigh bone in the hip joint (the femoral head) regrows and remodels back to normal, or near-normal. The hip joint then returns to normal and is able to work as usual.
However, this can take two or more years after the condition first starts. Even after this time, there may be some stiffness remaining in the hip and there is an increased risk of arthritis in later life.
Further reading and references
Kannu P, Howard A; Perthes' disease. BMJ. 2014 Sep 23349:g5584. doi: 10.1136/bmj.g5584.
Kim HK, Herring JA; Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am. 2011 Jul42(3):285-95, v. doi: 10.1016/j.ocl.2011.04.007.
Shah H; Perthes disease: evaluation and management. Orthop Clin North Am. 2014 Jan45(1):87-97. doi: 10.1016/j.ocl.2013.08.005. Epub 2013 Sep 26.
Larson AN, Sucato DJ, Herring JA, et al; A prospective multicenter study of Legg-Calve-Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Joint Surg Am. 2012 Apr 494(7):584-92. doi: 10.2106/JBJS.J.01073.
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