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Plymouth Paediatric Orthopaedics

Perthes Disease

Perthes disease affects children’s hips. It is caused by a temporary interruption in the blood supply to the femoral head (ball of the ball and socket). The underlying reason for this interuption is unknown. As a result, the femoral head can become soft and misshapen.

It is more common in boys than girls, and usually occurs between the ages of 4 and 8 years old.

Children present with pain in the hip, thigh or knee, a limp or stiffness. An initial X-ray may be normal, so if suspected, follow up X-rays at an interval of 6 weeks may be required to confirm the diagnosis.

The principle of treatment is to keep the soft femoral head (like a jelly) mobile and contained within the acetabulum (the mould), and to decrease the forces across the hip by off-loading it using crutches. Our expert physiotherapists play a pivotal role in these treatments.

Very occasionally an operation may be required to assess the hip further. An arthrogram, where radio opaque dye is injected into the hip allows us to see how well contained the hip is, and how freely it moves. Even more infrequently an operation to redirect the femoral head deeper into the acetabulum is needed – an osteotomy.

Swimming is encouraged as it allows the hip to move freely with minimal forces across it. Other sporting activities are usually restricted for a period. Generally speaking the earlier the onset of the Perthes, the better the prognosis.