Treatment of Perthes Disease in Children

At Herzliya Medical Center in Israel, the children’s Orthopedic Department is leading in diagnosis and treatment of various pathologies of the musculoskeletal system, including treatment of Perthes’ disease among children of all age groups. Orthopedic specialists use various methods involving conservative and invasive treatments, while rehabilitation uses the most advanced technology to effectively restore the motor function of the affected joint after treatment.

What is Perthes’ Disease?

Perthes disease (Legg-Calvé-Perthes disease), is a condition affecting the hip. The femoral head of the hip undergoes structural change due to impaired circulation, mainly within the cartilage of the hip region. Severe ischemia may lead to degeneration of bone and cartilage or avascular necrosis; a compression fracture of the head, followed by deformation and dysfunction of the hip joint. The disease is frequently observed among boys under 14 years of age.

Causes of Perthes Disease

Possible causes of Perthes’ disease include:

• Congenital hip joint pathology
• Traumatic hip injury
• Metabolic disorders
• Children with weakened or deficient immune systems may be at higher risk for complications from an infection
• Excessive stress on the joint, caused by deformation of the spine and uneven distribution of weight while walking
• Infringement of spinal nerves at level 4 lumbar vertebrae, developed as a result of trophic changes from innervation of blood vessels

Symptoms of Perthes Disease in Children

Legg-Calvé-Perthes disease is usually characterized by damage to one side of the hip joint. Symptoms associated with the damage are as follows:

• The pain of the thigh and groin, as well as of the knee region
• Pain expressed during exercise and less pain while sedentary
• A marked change of gait and impaired physical development.
• Limited range of motion capabilities of the hip joint (contracture) and subsequent structural changes
• Develop secondary damage to gluteus muscle

In addition to the painful physical symptoms, Perthes’ disease may interfere with developmentally appropriate social adjustment among peers, contributing to the development of psychological difficulties.

Diagnosis of Perthes Disease at HMC

Patients in the pediatric orthopedics department at HMC in Israel undergo a complete and thorough examination, allowing experts to determine the degree of damage and the cause of Legg-Calve-Perthes. The primary basis for the diagnosis of the disease is based on:

• Collection of a detailed medical history, namely previous experience of development of clinical symptoms
• A physical examination conducted by an Orthopedic Specialist
• X-ray examination of the hip

In some cases, to confirm precise Perthes’ disease diagnosis, it is recommended that patients undergo computer or magnetic resonance imaging (MRI) of the hip joint, as well as an isotope bone scan.

Perthes Disease Treatment at HMC

Early treatment is carried out by specialists when the first symptoms of the disease are observed. Effective treatment in early stages helps to prevent the development of severe structural changes in the hip joint. Among the main treatments of Perthes’ disease in Israel are the following:

• Systemic administration of new generation, non-steroidal anti-inflammatory drugs are used to effectively suppress inflammation and pain
• Intra-articular drug administration
• Physical therapy to restore joint mobility and prevent contractures
• External fixation of the joint to prevent a progressive structural change of the joint

As symptoms progress, it is recommended to limit physical activity. Experts at HMC in Israel work to develop individual sets of exercises for rehabilitative purposes, to allow patients to regain function of the joint and prevent muscle atrophy.

Surgical treatment for Perthes’ disease in Israel has been carried out in cases of severe deformation and compression fractures. Surgery is strongly recommended for patients who have had a late diagnosis and a history of ineffective conservative therapy. At HMC in Israel, a variety of endoscopic, arthroscopic, and open surgical procedures on the hip joint. The primary objectives of surgery are:

• Addressing the root causes of Perthes’ disease (spinal deformity, spinal nerve impairment)
• Removal of dead portions of bone and fibrous structures that impede normal joint function
• Restoration of the anatomic integrity of the femoral head in order to preserve joint structures

Favorable prognosis is achieved through adherence to rehabilitation therapy and follow-up. Specialists at Herzliya Medical Center are dedicated to achieving great success in restoring the patient’s full movement.