Perthes disease is a condition that occurs in children and affects bone and joint health. It typically occurs in children between the ages of 4 and 10 and presents with symptoms such as hip limping and lameness. This disease is characterized by the destruction of bone tissue at the point where the femur meets the hip.

It's more common in boys, and early diagnosis positively impacts treatment. It occurs when blood circulation to the head of the femur is disrupted, leading to bone tissue damage. Although seen in one in 10,000 children, it's a rare condition and typically affects only one hip. However, in some cases, both hips can be affected, leading to confusion with other conditions.

In Perthes disease, growth and development during childhood are crucial. The disease typically presents with limping and hip and knee pain. Diagnosis is made in childhood through various tests and imaging methods.

This disease requires lifelong treatment and follow-up. Full recovery can take a long time. The disease's progression should be monitored with regular checkups throughout the treatment and even after recovery. Complications such as hip deformities, cartilage damage, and shortened femur can develop due to Perthes disease. Therefore, the effects of the disease in children should be constantly monitored, and treatment should be carried out under the supervision of a doctor.

Perthes disease symptoms

The initial symptoms of Perthes disease can often be mild and often include mild pain or discomfort. These symptoms can sometimes be overlooked. However, as the disease progresses, symptoms can become more severe. The most common symptoms of Perthes disease include:

• Pain in the hip and knee area
• Limping or limping
• Swelling in the legs
• Thinning of the leg circumference
• Difference or shortness in leg length
• Difficulty or limitation in joint movements

These symptoms can vary from patient to patient and can become more severe as the disease progresses or is left untreated. It's especially important for children to be examined by a pediatric orthopedic surgeon if they experience unexplained pain or discomfort. Early diagnosis and treatment of this condition are crucial for achieving better long-term outcomes.

What are the causes of Perthes disease?

While the exact causes of Perthes disease are not fully understood, research is being conducted on some factors that contribute to its development. Research into the causes of Perthes disease is ongoing. Possible factors contributing to the disease include:

• Gender : The disease is generally more common in boys.
• Childhood activities: Intense and excessive activities, long-term sports or high-intensity physical activities may increase the risk of disease.
• Genetic predisposition: Having a family history of Perthes disease may increase the risk of developing the disease.
• Blood flow problems: Certain problems with blood circulation, particularly conditions that reduce blood flow to the hip bone, may contribute to the development of the disease.
• Hormonal and metabolic factors: Some hormonal and metabolic factors, especially those related to bone growth and repair, are thought to be effective in the development of the disease.

Research into the causes of Perthes disease suggests that these factors may increase the risk of the disease. However, a full understanding of the causes and their precise effects on the development of the disease is still ongoing.

How is Perthes disease diagnosed?

Diagnosis of Perthes disease is based on a detailed examination by a specialist pediatric orthopedist. The following factors are considered during the diagnosis process:

• Patient history: Symptoms such as the patient's and family's complaints, the onset of symptoms, the duration and severity of pain are evaluated.
• Physical examination: The physician checks the patient's hip and leg movements, pain, and tenderness. During the examination, movements that cause pain and pain in the hip area are checked.
• Radiological imaging: X-rays are usually taken. The results of the X-rays show the condition of the hip bone, bone necrosis (death), and other signs. Diagnosis can be difficult in the early stages, in which case more detailed imaging methods such as MRI (magnetic resonance imaging) or CT scans may be used.
• MRI and CT scans: These imaging modalities can be used to support diagnosis, especially in early-stage cases. MRI and CT scans may be more sensitive in assessing bone tissue status and blood flow.
• Long-lasting pain: In children with complaints of pain in the hip region and no problems observed in the radiological findings, if the pain lasts longer than 10 days, an MRI examination may be performed, considering the possibility of Perthes disease.

By combining these findings, a diagnosis of Perthes disease is made. Once the diagnosis is made, a treatment plan is developed, tailoring a treatment regimen to the patient's specific condition.

Stages of Perthes disease

• Early Stage (Initiation): In this stage, the patient usually has no symptoms. Diagnosis may be made incidentally during radiological imaging.
• Active (Necrotic) Stage: In the second stage, symptoms of the disease appear. During this stage, bone tissue in the femoral head dies. During this stage, the patient experiences pain, limping, and other symptoms.
• Reactive (Reparative) Stage: In the third stage, the femoral head must be protected within its socket while the dead bone tissue regenerates. Treatment focuses on promoting the regeneration of the dead tissue and maintaining the femoral head in the hip joint.
• Resolution phase: In this final phase, bone tissue remodels and the structure of the femoral head improves. As a result of the treatment, the patient's symptoms subside and recovery begins.

Treatment for Perthes disease depends on its stage and the patient's condition. Early diagnosis and treatment can help restore bone tissue and prevent further progression of the disease.

What are the treatment methods for Perthes disease?

Treatment options for Perthes disease depend on the stage of the disease, the patient's age, and the extent of the disease. The following treatment options are typically used:

• Rest: During periods of severe pain, the patient may be advised to rest. During this period, activities may be limited and pain-relieving medications may be used.
• Physical therapy: In some cases, physical therapy programs can help reduce pain, strengthen muscles, and improve joint movement.
• Surgical interventions: Depending on the patient's condition, surgery may be necessary. Surgical interventions may be performed to retain the femoral head in the hip joint and correct deformities.
• Medication: Medications prescribed by a doctor may be used to relieve pain and control inflammation.
• Regular follow-up and monitoring: Treatment of the disease is a long-term process. Patients must be regularly monitored by a pediatric orthopedic surgeon and appropriate treatment methods must be implemented.

Treatment generally aims to halt disease progression, ensure proper femoral head development, and maintain hip joint health. Children may be restricted in their physical activities during treatment, and long-term treatment may be necessary. Early diagnosis and treatment are crucial for preventing disease progression and ensuring a healthy recovery. Therefore, parents are advised to consult a healthcare professional if their child experiences any hip or knee pain.

What happens if Perthes disease is left untreated?

If left untreated, Perthes disease can cause various complications and lead to permanent problems. If left untreated or not treated appropriately, the following conditions may occur:

• Deformities: Bone death due to impaired blood flow to the femoral head can cause changes in the shape of the femoral head. This can lead to deformities and deformities in the hip joint.
• Joint problems: As the disease progresses, problems with the hip joint may occur. This can lead to pain, stiffness, and limited movement in the hip joint. This can lead to permanent hip problems and early osteoarthritis.
• Long-term problems: If left untreated, Perthes disease can progress and significantly impact a patient's quality of life. Problems such as improper bone development, long-term disability, and limited mobility can occur.
• Femoral shortening: Damage and deformities to the femoral head can cause long-term leg length discrepancies. This can lead to leg length discrepancies and femoral shortening.
• Pain and limited mobility: Untreated Perthes disease can cause progressive pain and permanent limited mobility. This can negatively impact a patient's daily life and activities.

Therefore, early diagnosis and appropriate treatment of Perthes disease are crucial in preventing such long-term complications. Adhering to a physician's recommended treatment plan and regular follow-up can halt the progression of the disease and reduce the risk of potential complications.