Perthes disease is a chilhood disorder which mainly affects the hip in the body. In this disease condition, blood supply to the hip is temporarily blocked. This blockage causes the death of femur head. This causes irritation and burning sensation in the hip. In early times, it was described as a distinct form of hip arthritis. Children between the age of 4 years and 10 years are most commonly affected. The other names for perthes disease include Legg-Calve-Perthes disease , or Calve Perthes disease, or avascular necrosis.
Boys are more affected by perthes disorder than girls. Although many theories exists about its cause but actual reason is still unknown. The low blood supply to the femoral head causes instability in bone. As a result, bones become soft and easily breaks down. The reason for low blood supply is not known.
The symptoms of Perthes disease include:
- Hip and groin pain
- Length of affected leg is short
- Limited movement
- Stiffness in joint
The diagnosis include hip x-ray or pelvis x-ray. They help to show the deformity in the femoral head. During course of treatment, several x-rays are taken to identify improvement in condition. An MRI scan or bone scan is also done to detect any other deformity or the extent of bone damage. The treatment includes non-surgical procedure and surgical procedure.
- Non-surgical Treatment:
The non-surgical treatments, typically, use medications to lessen the pain and other discomforts. Other treatment procedures included are:
- Physical Therapy
Perthes disease causes stiffness in the hips. This stiffness results in the shortened muscles and ligaments. Physical therapy includes simple strengthening and stretching exercises which enhances hip flexibility. They help to hold the hip back in the socket.
Weight on the hip can increase the discomfort. To avoid this, crutches are used in the hip. They provide protection to joint from excessive weight.
A short period of complete bed rest is recommended to relief severe pain. In addition, traction is also advised. Traction provides gentle and steady force on the legs.
To hold the hip in its socket, use of leg cast is beneficial. It widely spreads both the legs apart. They are mainly recommended for 4 to 6 weeks until healing is over. Along with casts, braces are also used at night to enhance hip flexibility.
- Surgical Treatment:
The abnormal shape of the hip can also be improved by surgical treatments. The surgical methods include:
- Contracture release
The children who suffers from Perthes disorder are seen to hold legs across their body. The nearby tendons and muscles, are hence, shortened. As a result, the hips start to contract. This poor condition is treated using surgery. The contracted tissues are lengthened by surgery. Thus, the hip flexibility is completely restored.
- Joint re-alignment
Joint-realignment is more beneficial for children above 6 years of age. A more accurate shape to the hip joint is provided with realignment surgery. During surgery, tiny incisions are made in the pelvis or femur. Through these incisions the joints are assessed. Therefore, the joints are realigned in correct position. For fast healing, a bone plate is used to support the bones.
- Removal of excess bone or loose bodies
In this surgery, the extra bone around the head of femur is removed. In some cases, the damaged or torn cartilages are repaired or removed. This corrects the pain and limited motion in older children.
- Joint replacement
The joint replacement surgery is usually required at later-half of life. However, this surgery has a risk of fracture to bones. In some severe cases, damage to nerves may also occur.
During recovery period, vigorous activities should be strictly avoided. The activities include jumping, running, weight-lifting, etc. These activities worsens the symptoms. Medications such as tylenol, are used to control pain. However, these should be taken under the supervision of a doctor. Hot or cold packs enhances healing of affected hip. The complete recovery often takes 5-6 months.
The possible risks associated with perthes surgery are:
- Irregular hip shape
- Chances of hip arthritis
- Early wear-and-tear of joint