Perthes disease is a degenerative condition characterized by restriction of blood supply in the ball of the femur leading to bone death and a partial or complete collapse of the hip joint. This condition typically presents in young children, but its effects can sometimes continue into adulthood, causing a severe form of arthritis. Prognosis is greatly improved with an early diagnosis and implementation of intensive treatment regimes, according to an article published in "Dtsch Arztebl Int" in July 2009.
Treatment
Avoiding or delaying loss of hip joint function by protecting the femoral head from degradation is the primary goal, and treatment is focused predominantly on keeping the softened part of the femoral head within the socket of the pelvis in a process known as containment. Containment is known to slow progression of the disease, and is facilitated by improving hip mobility, which can be achieved via exercise and physiotherapy programs. In more severe cases in which the femoral head has become significantly deformed, surgical methods of containment are frequently required.
Leg Braces
Historically, leg braces that completely immobilize the hip joint were widely prescribed for treatment of patients with Perthes disease. However studies have highlighted significant adverse effects caused by this treatment, such as muscle atrophy, weight gain and social exclusion, according to an article published in "Journal of Child Orthopedics" in March 2007.
Physiotherapy
Rather than restricting hip motion, modern clinical evidence shows the prognosis of patients with Perthes disease is greatly improved by prescription of regular physiotherapy to increase to mobility of the hip. This relieves a build-up of pressure caused when the hip is kept in a fixed position for extended periods, according to Pediatric Orthopedics.
Exercise
Depending on the age of the patient and the severity of the disease, treatment may consist of no more than reducing types of mechanical stress that can exacerbate degradation of the hip joint. This form of treatment is usually only recommended for patients younger than 6 years of age, who have a good range of hip motion. These patients are advised to avoid physical activities such as running and jumping, and encouraged to take part in exercises which raise the heart rate without putting excessive stress on the hips, such as swimming and cycling, according to research published in "J Bone Joint Surg Br" in July 2008.
Surgery
A procedure known as a proximal femoral osteotomy may be required if severe damage to the femoral head has occurred. In this procedure, the head of the femur is cut and re-aligned deeper into the socket of the pelvis. Other procedures include a pelvic osteotomy, in which the socket of the pelvis is re-orientated to give greater coverage of the femoral head, according to Pediatric Orthopedics.
References
- PubMed.gov: "Dtsch Arztebl Int"; Perthes Disease Current Principles of Diagnosis and Treatment; M. Nelitz et al; August 2009
- PubMed.gov: "J Bone Joint Surg Br"; Perthes' Disease: Prognosis in Children Under Six Years of Age; F. Canavese, A. Dimeglio; July 2008
- Paediatric Orthopedics: Perthes
- PubMed.gov: "J of Child Orth"; The management of Legg-Calvé-Perthes' Disease; F. Hefti et al; March 2007
