Perthes disease
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Perthes disease is the idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head, also known as Legg-Perthes Disease and Legg-Calve-Perthes disease (LCPD). In more lay terms, it is caused by an interruption to the blood supply of the head of the femur close to the hip joint.
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Incidence
Caucasians are affected more frequently than other races, males are affected 4-5 times more often than females and it is most commonly seen in persons aged 3-12 years, with a median of 7 years of age. In the US, 1 in 1200 children younger than 15 years will have this disease.
Symptoms
Symptoms are hip or groin pain, exacerbated by hip/leg movement. There is a reduced range of motion at the hip joint and a painful gait. There may be atrophy of thigh muscles from disuse and an inequality of leg length. In some cases, some activity can cause severe irritation or inflamation of the damaged area including standing, walking, running, kneeling, or stooping repeatedly for an extended period of time.
Investigations
X-Rays of the hip joint are absolutely necessary. A bone scan may be useful in helping determine the extent of the avascular changes. A hip aspiration may be performed if there is suspicion of a septic arthritis.
Treatment
The goal of treatment is to avoid severe degenerative arthritis.
Treatment involves bedrest to take weight off the joint. It may require traction, leg braces, a plaster cast and physiotherapy. Surgery is only rarely necessary.
Orthopedic assessment is crucial. Younger children have a better prognosis than older children.
There are no drugs for treatment of Perthes. Analgesic medication should be given as necessary.
Prognosis
Children that have been diagnosed with Perthes' Disease after the age of 10 are at a very high risk of developing osteoarthritis.