What is Perthes Disease?
Perthes disease, which has become more common in the field of pediatric orthopedics, especially in recent years, is a hip disease specific to childhood. This disease occurs due to impaired blood circulation for an unknown reason in the head of a thigh bone called the femur. As a result, bone tissue death occurs and this condition is characterized by Perthes disease. While Perthes generally affects only one thigh, sometimes it develops on both sides, and this situation may cause it to be confused with different diseases. This disease can be seen in every child between the ages of 1.5 and 15, but the most common age range is between the ages of 4-10. This disease, which is 4 times more common in boys than girls, is generally referred to a physician due to disruption during walking, pain in the knee and hip area. Together with the diagnostic tests to be performed at this stage, children diagnosed with Perthes require lifelong follow-up and treatment. Recovery of the disease may take many years. Depending on the disease, problems such as hip deformities, femur shortness and cartilage tissue damage may develop in children.
The emergence of Perthes disease, the healing process and the period after the recovery period, patients should be examined continuously, the extent of the disease and whether the disease has recurrence should be examined at regular intervals after the patient has recovered.
What are the Symptoms of Perthes Disease?
Symptoms at the onset of Perthes disease are usually mild and therefore ignored by children or parents. The disease sometimes does not cause symptoms, sometimes it manifests itself as mild hip and knee pain. As the disease progresses, the severity of the symptoms increases. Other common symptoms of the disease are:
- limping,
- Pain in the knee and hip area,
- Swelling in the legs,
- Short legs,
- Leg diameter thinning,
- Symptoms such as difficulty in joint movements are common findings in Perthes disease.
These symptoms seen vary from case to case. However, the symptoms seen during the disease process may intensify from time to time and then alleviate. Since the symptoms of this disease are not apparent in some cases, a child orthopedist should definitely be consulted for pain that occurs for no reason in childhood, as the patient and parents cannot notice.
What Causes Perthes Disease?
The exact origin of Perthes disease is unknown. However, Perthes disease develops due to certain factors:
Having had joint membrane inflammation: This situation experienced in most people is one of the conditions that affect the disease the most. The reason for this is some pressure felt in the joint. In contrast to temporary joint membrane inflammation in the hip, this discomfort occurs for a much longer period of time.
Inherent factors: These are factors related to maturity in weight, height and bone density. For this reason, constitutional factors are among the most powerful theories about the disease.
Repeated minor injuries in the region: Violent games explain why Perthes disease is more common in men than in women.
Environmental factors: This disease is more common in children with nutritional deficiencies. Also, if there are smokers in the family, this can lead to Perthes disease.
Stages of Perthes Disease
The disease basically develops and progresses in 4 stages. In the first stage, mostly no symptoms are observed in the patient and the disease can only be detected during radiological imaging performed for different purposes. The stage in which early symptoms are observed is the second stage. In general, the stage in which the patient applies to a physician is also the second stage. Towards the end of the third stage, bone tissue death is observed quite clearly in some or all of the head of the femur. The state of regeneration of dead tissues of the body is a condition that applies to bone tissue. However, in the meantime, it is very important to ensure that the femoral head remains within its slot in the hip joint. The other purpose is to ensure that the body regenerates the dead bone tissue.
How is Perthes Disease Diagnosed?
In Perthes disease, the diagnosis is made together with a physical examination, anamnesis and radiography. MRI or tomography is not needed in most of the patients with the disease. However, MRI can provide diagnosis in the early stages of Perthes disease. If the results of the radiological findings are normal and the patient’s disruption occurs within a period of 7 to 10 days, MRI may be required.
What Is Done in the Treatment of Perthes Disease?
In Perthes disease, bone death, called necrosis, occurs in part or all of the femoral head due to the malnutrition of the femoral head. However, the necrotic bone is removed by the body and a new bone is formed. During the reconstruction process, since the bone is weaker and softer, collapses and fractures in the head bone can be seen in traumas such as falling, jumping and jumping. Because the reconstructed femoral head takes a shape according to the compression it has received. For this reason, it is aimed to keep the femoral head in the nest part of the hip joint in the treatment, and in this way, it is aimed to develop in a global structure.
The main purpose of the treatment is to maintain a good range of motion. Treatment with anti-inflammatory drugs and rest is recommended, especially in painful periods. The healing process of the disease takes 2-2.5 years. In this process, the child should be prevented as much as possible from engaging in extreme sports activities, participating in contact sports and jumping from heights. In addition, there is no restriction in the daily activities of the child.
In order to keep the femoral head in the nest, a plaster cast in an open position, surgical applications and using some orthoses are methods used by Pediatric Orthopedists. The long duration of the disease makes it difficult for children to adapt to plaster or orthosis treatment. For this reason, many orthopedists turn to surgical treatment when necessary.
