Perthes' disease is a condition where the top of the thigh bone in the hip joint (the femoral head) loses its blood supply and so the bone is damaged. The bone gradually heals and reforms but Perthes' disease may cause hip problems later in life.
How common is it?
Perthes' disease mainly affects children who are aged between 4 and 12 years. Each year, about 1 in 10,000 children aged less than 15 years will get Perthes' disease. Four times more boys than girls are affected by the condition.
Perthes' disease usually only affects one hip. But both hips are affected in about 1 in 7 children who have Perthes' disease.
What is the cause?
In Perthes' disease, the part of the thigh bone in the hip joint (called the femoral head) loses its blood supply and the affected bone then dies. The blood supply gradually returns back to normal. New bone tissue forms so the bone regrows but not necessarily back to normal.
Find out more about the cause of Perthes' disease.
What are the symptoms?
Symptoms tend to develop gradually and they can include:
- A limp.
- Pain in the hip and groin area. Sometimes pain is felt in the knee or the thigh.
- Stiffness and a reduced range of movement of the affected hip.
- Muscle wasting in the thigh of the affected leg.
- Shortening of the affected leg.
Learn more about the symptoms of Perthes' disease.
Are there any tests?
The diagnosis can usually be made by a doctor's examination of the hip, plus an X-ray. Sometimes other tests may be needed if the diagnosis is not clear or if a more detailed picture of the hip joint is needed. Possible tests may include:
- A magnetic resonance imaging (MRI) scan.
- A bone scan.
- An X-ray where dye is injected into the space within the hip joint (this is called an arthrogram).
Blood tests and a sample of fluid from the hip joint may also be needed to rule out other problems, such as an infection of the bone or the joint.
What are the treatments?
The treatment will vary depending on the age of your child and how badly the hip is affected.
- In younger children (less than 6 years old) and those with mild disease, Perthes' disease will often heal well without any specific treatment apart from physiotherapy and home exercises.
- If the symptoms are bad then bed rest and crutches may be needed.
- Some children with Perthes' disease need to wear a plaster cast or a special leg brace.
- Surgery may be an option for some children.
Find out more about the treatments for Perthes' disease.
What is the outcome?
The main problem is that the part of the thigh bone in the hip joint (the femoral head) may not re-form properly. This can lead to permanent damage to the hip joint. This may cause stiffness of the hip joint. It can also cause arthritis of the hip joint at an earlier age than usual - for example, at around the age of 40 years.
The younger the child is when Perthes' disease develops, the better the chance of a good outcome. Children who develop Perthes' disease after about the age of 8-9 years have the highest risk of permanent hip joint problems, such as stiffness and arthritis.
The more severe the condition, the greater the risk of permanent problems with the hip joint.
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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