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Perthe's disease

Perthes disease (Legg–Calvé–Perthes disease) is a childhood hip disorder caused by temporary loss of blood supply to the femoral head, leading to avascular necrosis, fragmentation, reossification, and eventual healing. It commonly affects children aged 4–8 years, more often boys, and usually presents with a painless limp, hip/groin or referred knee pain, and restricted abduction and internal rotation. Treatment aims to maintain femoral head containment and preserve a congruent, mobile hip joint.

Perthes disease, or Legg–Calvé–Perthes disease, is a childhood disorder of the hip caused by a temporary interruption of the blood supply to the femoral head, resulting in avascular necrosis of the capital femoral epiphysis. It most commonly affects children between 4 and 8 years of age and is more frequent in boys. The condition is usually unilateral, although bilateral involvement can occur. Children typically present with a limp, intermittent pain in the hip or groin, or referred pain to the thigh or knee. Examination commonly shows restriction of hip abduction and internal rotation, sometimes with muscle wasting and a positive Trendelenburg sign. The disease progresses through stages of necrosis, fragmentation, reossification, and healing/remodelling, during which the femoral head may become flattened or deformed. Diagnosis is mainly based on plain radiographs, while MRI can detect early disease before obvious X-ray changes appear. Prognosis depends on factors such as the child’s age at onset, the extent of femoral head involvement, loss of containment, and residual deformity. Treatment aims to maintain hip movement, keep the femoral head well contained within the acetabulum, and allow it to heal in the most spherical shape possible. Younger children with limited involvement can often be managed conservatively with activity modification, physiotherapy, and observation, whereas older children or those with significant extrusion or deformity may require surgical containment procedures such as femoral or pelvic osteotomy.

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