Perthes Disease
EDP Column by Dr Ketan Dhatariya

Georg Perthes was a German surgeon who lived between 1869 and 1927. The condition named after him was in fact first described by a Czech surgeon, Karel Maydl, in 1897. However, three men simultaneously described the condition in different parts of the world in 1910, an American surgeon, Arthur Legg, a French surgeon, Jacques Calvé, and Perthes. As a result, the condition is correctly known as Perthes-Calvé-Legg disease to honour most of these individuals.

The disorder affects the top part to the thigh bone, the femur. The part of the femur that fits into the pelvis is called the femoral head. In children the blood supply to this area of the femur is very unusual. It does not have its own direct blood supply, but it is derived from small blood vessels that pass around the bone. Occasionally the bone grows faster than the blood supply and the bone dies away. The can occur on one or both sides. The bone dies over a period of about 3 weeks. The condition is associated with moderate pain in the hip and front of the thigh, with stiffness and restricted movement. There may also be a slight limp of the involved leg. The limp becomes worse as result of the wasting and shortening of the femur. The blood supply eventually returns and allows new bone cells to appear in the region over the next 6 to 12 months. This new bone then replaces the old bone within 2 to 3 years. In adults, the blood supply to the femoral head is much better.

Perthes is usually diagnosed in children between the ages of 3 and 10 years old. The condition can be inherited, and when it is, it is usually bilateral. However, boys tend to get the non-inherited condition 4 times more frequently than girls, when only one side is usually affected.

The condition does not always need active intervention. It used to be common practice to confine these children to bed for 2 or 3 years, but this was shown not to affect the long term outcome. It often gets better on its own, but sometimes it may be necessary to immobilise the joint or even have surgery. In the long term there is a risk of osteoarthritis. As always, if you are concerned, or your doctor says something to you that you do not understand, ask them to explain things in a way that you do understand.

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