Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Properly called Legg-Calvé-Perthes disease (LCPD) this condition was named after the healthcare providers who first described the disease in the early 1900s, but the condition still remains incompletely understood.
Treatment remains controversial, sometimes requiring surgery in the childhood years, other times being managed with nonsurgical treatments. Younger children often do best with nonsurgical treatment, whereas children diagnosed at a later age may do better with surgical intervention. Research is ongoing to determine the causes, prognostic factors, and ideal treatment of Perthes disease.
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Perthes disease tends to occur in children between the ages of 4 and 10 years old. It can occur during a broader range of ages, but it most commonly emerges in those childhood years. The condition is much more commonly seen in boys than girls.Many children diagnosed with Perthes disease are found to be skeletally immature compared to other children their age; they often appear younger than their chronological age.
Most children who have this condition will develop mildhip discomfortor a limp that brings this condition to the attention of their healthcare provider. The most common signs of Perthes disease include:
In addition to these symptoms, muscle weakness can develop in the extremity and more advanced cases of this condition. One specific test that your healthcare provider will look for is a so-called “Trendelenburg sign.” When standing on the affected leg, an abnormal tilting of the pelvis is indicative of weakness in the abductor muscles of the hip.This Trendelenburg sign is often seen in children with Perthes disease.
Children who develop Perthes disease have a problem with the bone and cartilage of the ball-and-socket hip joint. Over time, there is deterioration and deformity of the femoral head, the ball of the joint. Other conditions can also cause deterioration and deformity of the femoral head, and these conditions need to be considered as possible diagnoses as well as Perthes disease. Some other conditions that can mimic the signs of the disease includesickle cell diseaseandcorticosteroid treatment.
The cause of Perthes disease is not well understood, and there have been numerous studies to investigate the source of this condition. There is a question of possiblegenetic mutationsand blood clotting disorders that may contribute to the development of Perthes disease.However, the cause remains unknown.
What Is KnownChildren who develop Perthes disease have a disruption of the blood supply to the femoral head, causing deterioration of the bone and cartilage of this part of the hip joint. Essentially, because the blood supply is altered, the bone cells disintegrate, causing the hip joint to deteriorate. The severity of the condition depends on the extent of damage to the blood supply of the femoral head. In more severe cases, more of the femoral head is involved, leading to more extensive damage to the hip joint.
What Is Known
Children who develop Perthes disease have a disruption of the blood supply to the femoral head, causing deterioration of the bone and cartilage of this part of the hip joint. Essentially, because the blood supply is altered, the bone cells disintegrate, causing the hip joint to deteriorate. The severity of the condition depends on the extent of damage to the blood supply of the femoral head. In more severe cases, more of the femoral head is involved, leading to more extensive damage to the hip joint.
Diagnosis of Perthes disease is based on the clinical findings described above, as well as imaging studies to assess the degree of damage to the femoral head. There is no blood test that will diagnose Perthes disease. The diagnosis of this condition is made after eliminating other possible causes of deterioration to the bone of the femoral head.
X-raysare typically obtained to assess the degree of damage to the bone of the hip joint. These X-rays are used to classify the extent of the Perthes disease. While classification of Perthes disease has been around for a long time, the utility of this classification in guiding treatment and offering a prognosis is a subject of controversy.
In addition,MRIsare being used more commonly to evaluate children who have Perthes disease.Again, the utility of these tests in guiding treatment decisions is not entirely clear. While the tests are often done, there is limited evidence about how much these tests will offer information about the best treatments and prognosis.
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In general, there are three options for treatment of children with Perthes disease. The first option is to treat withphysical therapyto address restrictions in motion and weakness of the muscles surrounding the hip. The second option is to use a brace to immobilize the hip joint. The third option is a surgical procedure to realign the bone around the hip joint to try to remove pressure from the affected part of the femoral head. There are no medications, injections, or other pharmacologic interventions that have been shown to help with this condition. Ultimately, the goal of treatment is to try to minimize long-term damage to the hip joint while the condition spontaneously resolves.
Determining the best timing of surgery and which children will benefit the most from surgical intervention are subjects of ongoing research. Even with surgical intervention, children who have Perthes disease often develop permanent damage to the hip joint. This is generally well-tolerated in the teenage and young adult years. Young adults who had Perthes as a child will typically resume all normal activity without hip problems. As these individuals age, most will develop arthritis in their 50s, often requiringhip replacement surgery.
Summary
Perthes disease was described more than 100 years ago but remains a bit of a medical mystery. The cause of Perthes disease is not clear, and the ideal treatment remains controversial. In general, younger children do best with nonsurgical intervention, whereas surgery may be the best option in older children. Even with ideal treatment, children who have Perthes disease often develop arthritis of the hip joint later in adulthood. A hip replacement surgery is often necessary for these people.
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9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.OrthoInfo.Perthes disease.Pinheiro M, Dobson CA, Perry D, Fagan MJ.New insights into the biomechanics of Legg-Calvé-Perthes’ disease: the role of epiphyseal skeletal immaturity in vascular obstruction.Bone & Joint Research. 2018;7(2):148-156. doi:10.1302/2046-3758.72.BJR-2017-0191.R1Stevens WR, Jo CH, Tulchin-Francis K.Clinically derived biomechanical criteria for the Trendelenburg test.Clinical Biomechanics. 2020;78:105066. doi:10.1016/j.clinbiomech.2020.105066Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E.Legg–Calvé–Perthes disease overview.Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-zRodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E.Legg–Calvé–Perthes disease overview.Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-zWoratanarat P, Thaveeratitharm C, Woratanarat T, Angsanuntsukh C, Attia J, Thakkinstian A.Meta-analysis of hypercoagulability genetic polymorphisms in perthes disease: META-ANALYSIS OF POLYMORPHISMS IN PERTHES.J Orthop Res. 2014;32(1):1-7. doi:10.1002/jor.22473Jandl NM, Schmidt T, Schulz M, Rüther W, Stuecker MHF.MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment.Journal of Children’s Orthopaedics. 2018;12(5):472-479.Children’s Healthcare of Atlanta.Legg-Calve-Perthes disease.Johns Hopkins Medicine.Perthes Disease (Legg-Calve-Perthes Disease).
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.OrthoInfo.Perthes disease.Pinheiro M, Dobson CA, Perry D, Fagan MJ.New insights into the biomechanics of Legg-Calvé-Perthes’ disease: the role of epiphyseal skeletal immaturity in vascular obstruction.Bone & Joint Research. 2018;7(2):148-156. doi:10.1302/2046-3758.72.BJR-2017-0191.R1Stevens WR, Jo CH, Tulchin-Francis K.Clinically derived biomechanical criteria for the Trendelenburg test.Clinical Biomechanics. 2020;78:105066. doi:10.1016/j.clinbiomech.2020.105066Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E.Legg–Calvé–Perthes disease overview.Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-zRodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E.Legg–Calvé–Perthes disease overview.Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-zWoratanarat P, Thaveeratitharm C, Woratanarat T, Angsanuntsukh C, Attia J, Thakkinstian A.Meta-analysis of hypercoagulability genetic polymorphisms in perthes disease: META-ANALYSIS OF POLYMORPHISMS IN PERTHES.J Orthop Res. 2014;32(1):1-7. doi:10.1002/jor.22473Jandl NM, Schmidt T, Schulz M, Rüther W, Stuecker MHF.MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment.Journal of Children’s Orthopaedics. 2018;12(5):472-479.Children’s Healthcare of Atlanta.Legg-Calve-Perthes disease.Johns Hopkins Medicine.Perthes Disease (Legg-Calve-Perthes Disease).
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
OrthoInfo.Perthes disease.Pinheiro M, Dobson CA, Perry D, Fagan MJ.New insights into the biomechanics of Legg-Calvé-Perthes’ disease: the role of epiphyseal skeletal immaturity in vascular obstruction.Bone & Joint Research. 2018;7(2):148-156. doi:10.1302/2046-3758.72.BJR-2017-0191.R1Stevens WR, Jo CH, Tulchin-Francis K.Clinically derived biomechanical criteria for the Trendelenburg test.Clinical Biomechanics. 2020;78:105066. doi:10.1016/j.clinbiomech.2020.105066Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E.Legg–Calvé–Perthes disease overview.Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-zRodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E.Legg–Calvé–Perthes disease overview.Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-zWoratanarat P, Thaveeratitharm C, Woratanarat T, Angsanuntsukh C, Attia J, Thakkinstian A.Meta-analysis of hypercoagulability genetic polymorphisms in perthes disease: META-ANALYSIS OF POLYMORPHISMS IN PERTHES.J Orthop Res. 2014;32(1):1-7. doi:10.1002/jor.22473Jandl NM, Schmidt T, Schulz M, Rüther W, Stuecker MHF.MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment.Journal of Children’s Orthopaedics. 2018;12(5):472-479.Children’s Healthcare of Atlanta.Legg-Calve-Perthes disease.Johns Hopkins Medicine.Perthes Disease (Legg-Calve-Perthes Disease).
OrthoInfo.Perthes disease.
Pinheiro M, Dobson CA, Perry D, Fagan MJ.New insights into the biomechanics of Legg-Calvé-Perthes’ disease: the role of epiphyseal skeletal immaturity in vascular obstruction.Bone & Joint Research. 2018;7(2):148-156. doi:10.1302/2046-3758.72.BJR-2017-0191.R1
Stevens WR, Jo CH, Tulchin-Francis K.Clinically derived biomechanical criteria for the Trendelenburg test.Clinical Biomechanics. 2020;78:105066. doi:10.1016/j.clinbiomech.2020.105066
Rodríguez-Olivas AO, Hernández-Zamora E, Reyes-Maldonado E.Legg–Calvé–Perthes disease overview.Orphanet J Rare Dis. 2022;17(1):125. doi:10.1186/s13023-022-02275-z
Woratanarat P, Thaveeratitharm C, Woratanarat T, Angsanuntsukh C, Attia J, Thakkinstian A.Meta-analysis of hypercoagulability genetic polymorphisms in perthes disease: META-ANALYSIS OF POLYMORPHISMS IN PERTHES.J Orthop Res. 2014;32(1):1-7. doi:10.1002/jor.22473
Jandl NM, Schmidt T, Schulz M, Rüther W, Stuecker MHF.MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment.Journal of Children’s Orthopaedics. 2018;12(5):472-479.
Children’s Healthcare of Atlanta.Legg-Calve-Perthes disease.
Johns Hopkins Medicine.Perthes Disease (Legg-Calve-Perthes Disease).
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