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Perthes is a pediatric problem, usually occurring between the ages of 4 to 8 and more frequently found in boys than girls. For some reason, there is a temporary loss of the blood supply to the ball portion of the hip joint (femoral head). This causes a partial death of a portion of the femoral head. When the bone and cartilage lose its blood supply they eventually become soft and ultimately collapse. When the femoral head collapses it loses its circular and spherical shape and no longer fits well into the hip socket. This results in loss of motion of the hip joint and causes a limp. Over the long term, as the joint fit becomes less and less perfect, the cartilage wears out and eventually arthritis develops with bone rubbing on bone. The worse the joint fit, the earlier the onset of arthritis.
Children often have a slowly progressive painless limp and it usually takes several months before the child presents to the doctor. Pain can be caused when a child is active and sometimes the pain is found in the lower thigh or knee area.
The treatment of Perthes relies on two basic principles: preserving the motion of the hip joint and containing the femoral head in the socket. Anti-inflammatory medication, rest, and physical therapy are the most common treatments. Sometimes home traction or bracingis required.
Physicians who treat Perthes Disease
In patients younger than 18 years old: Joshua Abzug, MD
In patients older than 18 years old: Farshad Adib MD, Ted Manson, MD