Perthes disease is a pathological condition occurring during the growth phase, which leads to impaired blood supply and subsequent degeneration of the femoral head, a major component of the hip joint. The underlying cause is not fully understood, although several theories have been proposed, including infection, joint fluid abnormalities, trauma, and congenital anomalies. The disruption of growth hormone is believed to play a role in the development of this condition. Perthes disease predominantly affects boys, with a significantly higher incidence compared to girls. It typically manifests between the ages of 3 and 12, with a peak occurrence around 6-8 years old. Unilateral involvement is more common, while bilateral cases represent approximately 10% of occurrences. The disease presents with erosion, shrinkage, and deformity of the femoral head due to compromised blood circulation.
Symptoms:
The symptoms experienced by patients may not always be distinctly evident. Initially, there may be intermittent hip and knee pain, which is generally mild and can persist for several months without significant concern. Mobility of the hip joint becomes challenging and accompanied by discomfort. Pain and limping tend to worsen following physical activities or sports. Children who normally walk without any issues in the morning may exhibit a limp in the evenings. Typically, medical consultation occurs approximately 1-2 weeks after the limp is noticed. Children may perceive a sense of leg length discrepancy. Engaging in physical activities tends to exacerbate the symptoms.
- Knee discomfort
- Pain and restricted range of motion in the hip joint
- Limping
- Muscular weakness in cases of prolonged complaints.
The diagnostic process for this condition involves:
- Observation and examination findings from family members.
- X-ray imaging, although it may not reveal symptoms in the early stages. It requires high-quality images and expert evaluation.
- MRI scans, which are highly diagnostic but can be costly.
- Scintigraphy, a procedure that involves exposure to a significant amount of radiation.
The age at which the disease begins is significant, as those under the age of 8 have a higher likelihood of improvement. The disease progresses through four distinct stages:
- Stage 1: Increased fluid accumulation in the hip joint.
- Stage 2: Softening and damage to the cartilage.
- Stage 3: Erosion and shrinking of the growth core in the hip joint.
- Stage 4: Improvement and regeneration.
However, even with improvement, there is a possibility of deformities in the hip joint, which can predispose individuals to hip osteoarthritis in later stages. All patients go through these stages sequentially, and the duration of the disease can vary from a few months to several years. The age at which the disease starts is a crucial factor, as those who experience an earlier onset generally have a better prognosis. Specifically, individuals who develop the disease before the age of 7 tend to experience a greater degree of improvement.
Various factors influence the treatment approach, including:
- Age at disease onset.
- Early diagnosis.
- Extent and severity of hip joint involvement.
- Displacement of the femoral head from the acetabulum.
- Presence or absence of restricted hip movements.
While the age of disease onset and the degree of hip involvement cannot be altered, managing muscle spasms can help maintain the position of the hip joint. The development of the hip joint relies on the harmonious interaction between the two bones, ensuring their proper alignment.
