Perthes disease

Better Health Channel, 2019 Houghton, 2009 Royal Childrens Hospital, 2007 Royal Childrens Hospital Melbourne, 2022

Perthes disease is an osteonecrosis of the femoral head. Disruption of blood flow to part of the femoral head causes an avascular necrosis (softening and collapse) of the affected bone, preventing it from fitting snugly into the hip socket (acetabulum). Perthes disease occurs in children aged 3 to 12 years and is much more common in boys. Children usually present with a limp, with or without pain experienced in the hip, groin, or knee. Pain experienced in the knee may be the only symptom. On examination, hip abduction and internal rotation are limited. Perthes disease is associated with long-term morbidity if untreated.

If Perthes disease is suspected, perform a hip X-ray and, if the diagnosis is confirmed, refer the patient to hospital for review by an orthopaedic surgeon. Symptoms associated with Perthes disease are often present early; however, X-ray changes can evolve over time. Pending specialist review, physical activity should be restricted and weightbearing reduced by the use of crutches if possible. If pain relief is required in the interim, use the drug regimens in Oral drugs for mild, acute nociceptive pain in children.

Note: If Perthes disease is suspected, perform a hip X-ray and, if the diagnosis is confirmed, urgently refer the patient for review by an orthopaedic surgeon.