Perthes Disease
The Hospital for Joint Diseases (HJD) Center for Children uses many techniques to deal with Perthes Disease or, Legg-Calve-Perthes as is it also referred to, and our doctors are experts in the field. Early treatment of this condition can lessen problems in the hip later in life.
Definition
Perthes Disease affects the upper end of the femur thus affecting the structure of the hip. In this condition, the blood supply to the hip is disturbed causing the bone to die but pain is often felt in the knees and not in the hips. More boys than girls tend to have Perthes Disease, however, girls often have a more severe case of the condition.
Causes
The exact cause of Legg-Calve-Perthes disease is unknown. It is thought to be linked to disrupted blood supply to the bone. Perthes is caused by an interruption of blood flow to the thigh bone. When the blood flow is interrupted, the thigh bone then dies.
Risk Factors
Perthes Disease can affect children of any age but it is most common in boys ages 4 to 8. There is no specific cause known for this condition.
Symptoms
Common symptoms of Perthes Disease are:
- Knee pain
- Thigh/groin pain
- Shortening of the leg
- Legs of unequal length
- Stiffness in the hip
- Difficulty walking
- Walking with a limp
- A limited range of motion
Diagnosis
X-rays can usually diagnosis the condition.
Treatment
Surgical Care
There are many surgery options used at the HJD Center for Children including Tenotomy which releases an atrophied muscle that has shortened due to limping. Once the surgery is completed, a cast is applied for about six to eight weeks to allow the muscle to grow.
Another method used by the doctors at the Hospital for Joint Diseases Center for Children are different types of Osteotomies which involve cutting the bone so it can be repositioned. What often happens with Perthes Disease is that the ball that goes into the hip socket becomes soft and, can slip out of the socket. In that situation a Femoral Varus Osteotomy is performed in order to secure the ball in the socket.
An Osteotomy can also be done above the hip socket so the femoral head will have less likelihood of becoming deformed. A Shelf Arthroplasty, or formation of the joint, is also performed with the Osteotomy which gives added coverage to the femoral head from the top of the socket.
Non-surgical Care
Anti-inflammatory medications are used to lessen inflammation of the joint or the tissue surrounding the hip joint.
A child with Perthes Disease may walk with a limp due to stiffness experienced in the hip. The doctors at the HJD Center for Children strive to help restore a range of motion in the hip joint. To achieve this, the child can be encouraged to walk with crutches and participate in physical therapy. Bed rest in traction may be needed in some cases and is done in a hospital or at home.
A cast can also be used to keep the head of the femur within the hip socket. After the cast is removed exercises and physical therapy are done to create a range of motion.
Prevention
There is no known way to prevent Perthes Diseases / Legg-Calve-Perthes disease.
Resources
The Wallace B. Lehman, M.D. Center for Pediatric Orthopedic Surgery
http://www.nyuhjd.org/hjd/centerforchildren/patient/wallace.html
The New York Institute for Limb Lengthening and Reconstruction http://www.nyuhjd.org/hjd/centerforchildren/patient/limb.html
The Center for Pediatric Rehabilitation and Pediatric Medicine
http://www.nyuhjd.org/hjd/centerforchildren/patient/ped_rehab.html
The NYU Hospital for Joint Diseases Pediatric Physical and Occupational Therapy Department
http://www.nyuhjd.org/hjd/centerforchildren/patient/rehabilitation.html
Child Life Program at Center for Children
http://www.nyuhjd.org/hjd/centerforchildren/patient/child_life.html
Music Therapy at Center for Children
http://www.nyuhjd.org/hjd/centerforchildren/patient/music_therapy.html
To make an appointment at the NYU Hospital for Joint Diseases Center for Children, please call 212-598-6205