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Treating Perthes Disease

Treating Perthes Disease

by | May 18, 2022 | Hip Disorders

Perthes disease, also known as Legg-Calvé-Perthes disease, is a childhood disorder of the hip. The disease affects the ball portion of the hip joint, known as the femoral head. Perthes is uncommon — approximately five to 10 children per 100,000 will be diagnosed each year — and it more commonly affects boys — 1 in 760 boys. Here are some interesting facts about this pediatric hip condition.

What Happens to the Hips in Perthes Disease
In a normal hip joint, the round femoral head of your femur fits perfectly into the round socket of the pelvis. Perthes disease interrupts the blood flow to the femoral head, causing all or part of it to die due to the lack of blood. The bone death is medically referred to as osteonecrosis.

Once the bone dies, the femoral head is more prone to breakage and heals poorly in older children. As a result, the pressure and weight on the bone from normal rigorous activities can cause the round portion to become flat over few months to a year after the diagnosis. For one to two years after bone death occurs, new bone gradually begins to fill in the areas where the body has removed the dead bone.

The Cause of Perthes Is Still Unknown
While we know what happens to the hip to alter the round shape of the femoral head, we still don’t know what causes the precipitating interruption of blood flow. We also know that Perthes is not heritable, since less than five percent of the patients have a family history of the disease. However, some other heritable hip conditions or blood disorder can mimic Perthes, such as inherited bone dysplasia like multiple epiphyseal dysplasia and sickle cell disease. History of taking corticosteroid for treatment of asthma, inflammatory conditions or cancer can also produce bone necrosis that mimics Perthes.

Diagnosing Perthes Disease
Because so many other diseases can mimic the symptoms of Perthes, it is known as a disease of exclusion. Doctors will rule out other conditions by taking a careful medical history and performing a physical exam. The physician will typically ask about the following diseases to rule them out:

  • Family history of hip disorders or early joint replacement
  • Steroid use, such as for asthma
  • Prior hip surgeries
  • History of sickle cell disease
  • History of hip infection
  • History of endocrine or clotting disorders

To confirm a potential Perthes diagnosis, doctors will perform X-rays of the hips. If an X-ray is taken too soon after symptoms have begun, it may appear normal. In that case, physicians can order a very sensitive diagnostic test called perfusion MRI if they still suspect Perthes.

Treatments and Complications
The body will naturally remove and replace the dead bone of the femoral head with new bone, so, to some extent, Perthes is self-healing. However, the healing process may be slow and even after healing has taken place, the femoral head may not return to its original round shape. When that fails to happen, patients may experience long-term complications, such as pain, stiffness and arthritis later in life.

Until the healing phase is complete, nonsurgical treatments might include crutches, wheelchairs, casting and/or bracing, and reduced physical activity. Surgical treatments might include pelvic or femoral osteotomy a process that re-orient the pelvis or femur. In older children, another treatment option is to make bone channels to speed up healing and to inject bone marrow stem cells.

While Perthes is in some ways self-healing, femoral heads sometimes don’t heal properly but there are other treatment options are available. With the interventions we have today and new treatment knowledge about the condition, those with Perthes can usually return to daily activities and sports activities without problems.

Learn more about the various hip conditions our experts treat.

Recognizing Adolescent Hip Conditions

Recognizing Adolescent Hip Conditions

by | Aug 21, 2019 | Hip Disorders

Key messages from a presentation by staff orthopedist, David A. Podeszwa, M.D., at Coffee, Kids and Sports Medicine. Article originally published in first quarter, 2018 issue of Pediatric Society of Greater Dallas newsletter. 

Watch the lecture
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Recognizing Hip Conditions in the Pre-Teen and Teenager

Kids of all ages complain frequently of aches and pains around the hip and it is really easy to brush them
off. I would be lying if I said that I haven’t done it to my own children. For the super-active child/teen who participates in high impact activities year-round, it is easy to explain away complaints of hip pain as simple overuse. The combination of anti-inflammatories, stretching and playing through the pain is a common remedy. At the opposite end of the spectrum is the video gamer or book lover who is more sedentary and less interested in exercise. Their complaints of hip pain are easily attributed to deconditioning and weakness. Becoming more active is the simple remedy. Unfortunately, not all hip pain can be ignored. Missing certain conditions early in their presentation can have significant long-term pain and functional consequences. Below are several important pearls to remember that will help you avoid missing a serious hip condition when evaluating a patient with hip pain.

  1. Hip disorders can present with hip or knee pain. Sorting out the etiology and location starts with a good history and physical exam. Is the chief complaint pain, limp, or decreased motion? Some disorders can present without pain and only a limp. Where does it hurt? Hip disorders can present with hip (anterior, lateral, groin), thigh or knee pain. Complaints of constant pain that does not resolve with rest, is worse with weight bearing, limits hip range of motion, and is not improved with anti-inflammatories should be red flags for a significant underlying condition. Physical exam may demonstrate pain with palpation at the anterior superior iliac spine, iliac crest, and or greater trochanter. Pain with range of motion or significant asymmetry in hip range of motion should also be concerning.
  2. Children and adolescents do not get “groin pulls.” Recurrent limping and/or hip pain (especially groin pain) unresolved with rest is likely to have an underlying etiology. “Groin pull” is an easy answer, but it is never the correct one.
  3. An adolescent limping with his/her foot turned out and complaining of hip or knee pain has a slipped capital femoral epiphysis (SCFE) until proven otherwise by an AP and frog-lateral of both hips. Range of motion of the hip will likely be painful, especially with internal rotation when the hip is flexed. In severe cases, there will be obligate external rotation (and often abduction) when flexing the hip. In addition, any pre-teen or teen who presents with thigh or knee pain should have their hips examined as well. Referred pain is very common. Examining the hips in the face of knee pain will help prevent you from missing a serious hip condition. Delay in diagnosis is very common and is correlated with a more severe deformity and poorer outcomes.
  4. Hyperactive boys under the age of 10 who present with a limp (without pain or with vague complaints of hip, thigh or knee pain) should have an AP pelvis and frog-lateral of the hip to evaluate for Legg-Calve-Perthes disease. Far more common in boys than girls (4:1), this condition is most common between 4 and 10 years of age. The affected child is usually small and young appearing for his/her age. The child is able to bear weight, the pain or limp is usually worse with increased activity and there will not be any systemic signs or symptoms. Early diagnosis and treatment can make a significant difference in outcome. Once diagnosed, please refer to a pediatric orthopedist.
  5. Adolescents with hip pain and fever have septic arthritis of the hip until proven otherwise. Transient synovitis most commonly affects children 4-9 years old. Be very skeptical of this diagnosis in any child outside this age range. If the child is younger than four or older than ten years of age with hip pain and fever, think septic arthritis first. The child with transient synovitis may be able to ambulate and may tolerate gentle passive range of motion of the hip. He/she will commonly be afebrile. The CRP is usually <2 mg/dL, ESR usually <40 mm/hr, and WBC usually <12K cells/mL. A child with either transient synovitis or early septic arthritis will respond to ibuprofen. Ibuprofen should not be used as a diagnostic tool, but as a treatment for transient synovitis once the diagnosis is made. The differential diagnosis includes Lyme disease, gonorrhea, post-streptococcal reactive arthritis and hemophilia. Aspiration of the hip with cell count, gram stain, and cultures is the definitive diagnostic procedure for septic arthritis.

As I was taught and I often tell trainees, you don’t have to know what’s wrong, just recognize something is not right. Remembering these pearls will help you recognize when hip pain is really a problem.

Preliminary Laboratory Testing Indicates Positive Outcome in the Treatment of Legg-Calve-Perthes Disease

Preliminary Laboratory Testing Indicates Positive Outcome in the Treatment of Legg-Calve-Perthes Disease

by | Oct 11, 2018 | General News, Press Coverage

Washington, DC, October 11, 2018 –(PR.com)– The Legg Calve Perthes Foundation, in partnership with Dr. Harry Kim of the Texas Scottish Rite Hospital for Children and the University of Texas Southwestern Medical Center in Dallas, Texas has been selected to showcase preliminary laboratory results of this research at the 2018 National Organization of Rare Disorders (NORD) annual summit. On October 15-16th, the annual NORD Conference will boast over 700 attendees. “This is truly an honor to both become a NORD member and have our laboratory findings shared with NORD attendees in the same year,” said Dr. Harry Kim, MD.

Kim and his research team consisting of Olumide Aruwajoye PhD; Thomas Wesley Mitchell; Michael Kutschke BS; Vishal Gokani BS; and Naga Suresh Adapala PhD surgically induced femoral head osteonecrosis in an experimental model of Legg–Calvé–Perthes Disease. For those unfamiliar, Perthes disease is a childhood hip disorder initiated by a disruption of blood flow to the ball of the femur called the femoral head. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing. Perthes disease is one of the most common hip disorders in young children, occurring in roughly 5.5 of 100,000 children per year. Perthes disease usually occurs in children aged 4-10 years. Boys are affected about three to five times more often than girls. New cases of Perthes disease rarely occur after age of 14 years. There is no known cure today.

Kim and his team previous found high levels of an inflammation producing protein called interleukin 6 in the hip joints of patients with Perthes disease. Based on this finding, their research hypothesis was that anti-interleukin 6 therapy would improve chronic hip synovitis and promote bone healing in an experimental model of Perthes disease. Dr. Kim is the Director of the Center for Excellence in Hip Disorders at the Texas Scottish Rite Hospital for Children. His commitment to returning children to their childhood is unfound, and has treated hundreds of Perthes Disease cases in children over the course of his 20-year career.

Findings conducted from this study were positive and significant, as this is the first study to investigate the effects of anti-IL-6 therapy on femoral head osteonecrosis. The results indicated both a decrease in hip synovitis score and significant increase in bone rebuilding. “More funding is needed to continue these research efforts to cure Perthes disease, and the partnership with the Legg Calve Perthes Foundation will help pave the way,” said founder, Colleen Rathgeber.

About Legg Calve Perthes Foundation
The Legg-Calve-Perthes Foundation is a national educational organization dedicated to helping adults and children living with Perthes, and providing support with the associated difficulties that often come with the Perthes diagnosis. The Foundation’s mission is to create a centralized support community to improve the research, education, and awareness of those diagnosed with Perthes.

Contact Information:
Legg Calve Perthes Foundation
Colleen Rathgeber
202-505-9360
Contact via Email
perthes.org

Read the full story here: https://www.pr.com/press-release/767208