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Perthes disease
How is it treated?
The main principle of treatment is to attempt to preserve movement of the affected hip. This is usually achieved with a combination of conservative measures which can include rest, physiotherapy or anti-inflammatory medications. Another principle of treatment is to “contain” the head of the femur within the socket. Conservatively this can be achieved by the use of splints or braces. This can also be achieved surgically, altering the angle of the bones at the hip. Sometimes this is done to the upper femur and sometimes to the bone around the socket of the hip. Newer treatments are being tried and these can include distraction of the hip with an external frame.
The outcome in this condition is variable. Sometimes the shape of the hip remains excellent and at other times the hip can become flattened and movement reduced. The most important factor appears to be how much of the hip is affected by the loss of the blood supply. The more of the hip that is involved the worse the prognosis. Another major factor is how old the patient is at the onset of Perthes disease. The younger the patient the better, as the body has time to adapt and remodel with further growth. In those patients younger than five years there is often, but not always, a reasonable prognosis.
If the final shape of the femoral head is disturbed, movement of the hip may be reduced and the possibility of early degenerative changes (osteoarthritis) increase.
The other hip may be involved at a different time in childhood in up to 10% of patients.
What are the causes?
| Inheritance patterns and prenatal diagnosis 
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