Perthes (also called Legg-Calve-Perthes disease) is a rare childhood condition that affects the hip. It occurs when the blood supply to the head of the femur (thighbone) is temporarily disrupted. Without enough blood to the location, the bone cells die. This is called avascular necrosis. This process can last many years. This typically occurs in children between ages 4 and 10 and is more common in boys than in girls.
The cause of the condition is unknown. One of the earliest symptoms of Perthes is a change in the way your child walks and runs. Your child may limp and/or have decreased motion of the hip joint. Other symptoms include pain in the hip or groin and leg pain that worsens with activity but goes away with rest.
There are four stages of Perthes:
- Initial/necrosis stage. The first stage of this process includes loss of blood supply to the top of the femur bone. The hip joint is irritated and swollen. This is when your child may start showing signs of Perthes such as limping or walking differently. This stage may last for months.
- Fragmentation stage. Your child’s body will remove the dead bone from the hip and replace it with soft bone. During this stage, the bone is very weak and can break apart easily. For this reason, it is necessary to restrict your child’s activities for a while.
- Re-ossification stage. During this stage, new strong bone grows. This stage is the longest stage of Perthes and can last a few years.
- Healed stage. The process is complete. The new bone has grown, and the top of the femur has reached its final shape. In most cases, children with Perthes grow into adulthood without any other hip problems.
Diagnosis of Perthes
Doctors at Riley at IU Health use X-rays to help diagnosis and monitor. In some cases, a magnetic resonance imaging (MRI) scan is needed to check the progression of the damage and healing of the bone.
Treatments
Treatments
Treatment of Perthes may vary based on how old your child is when the condition is diagnosed and how severe the condition is when diagnosed. The goal of treatment is to help the bone grow back into the rounded shape of a normal hip to make sure the head of the femur (the “ball” of the “ball and socket” joint) fits into the hip joint. To do this, it is recommended that your child’s activities be limited. Your child will need to avoid high-impact activities like running and jumping. In some cases, the doctor may recommend crutches or a walker to prevent any weight on the hip joint.
Your child's orthopedic doctor will observe your child by scheduling regular follow-up appointments with X-rays to monitor the joint.
Additional treatment may include anti-inflammatory medicines (such as ibuprofen), casting or surgery to re-establish the proper alignment of the bones of the hip and to keep the head of the femur deep within the joint until healing is complete. The orthopedic surgeon may recommend physical therapy or prescribe exercises that help prevent hip joint stiffness.
Key Points to Remember
Key Points to Remember
- Perthes (also called Legg-Calve-Perthes disease) is a rare childhood condition that affects the hip. It occurs when the blood supply to the head of the femur (thighbone) is temporarily disrupted.
- One of the earliest symptoms of Perthes is a change in the way your child walks and runs.
- There are four stages of Perthes: initial/necrosis stage, fragmentation stage, re-ossification stage and healed stage.
- The goal of treatment is to help the bone grow back into the rounded shape of a normal hip to make sure the head of the femur fits into the hip joint.
- Treatment includes avoiding high-impact activities like running or jumping and regular follow-up appointments. Treatment may also include anti-inflammatory medicines, casting or surgery.
Support Services & Resources
Support Services & Resources
More information about Perthes can be found at the online resource below.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The American Academy of Orthopaedic Surgeons shares in-depth information on the treatment of Perthes on its educational website, OrthoInfo.org.
Locations
Locations
Locations
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.
Riley Outpatient Center at IU Health
Pediatric Orthopedics & Sports Medicine
575 Riley Hospital Dr
Indianapolis, IN 46202
IU Health North Hospital Medical Office Building
Pediatric Orthopedics & Sports Medicine
11725 N Illinois St
Carmel, IN 46032