Perthes disease in children: lameness, x-rays and treatment

Other names: Болезнь Пертеса, disease Легга-Кальве-Пертеса, остеохондропатия головки бедренной кости, асептический некроз головки бедра у ребёнка, ребёнок хромает и жалуется на колено, Пертес тазобедренного сустава

Perthes disease is a disruption of the blood supply to the head of the femur in a growing child, due to which part of the bone tissue temporarily dies and then gradually recovers. Boys aged 4–10 years are most often affected; usually one joint is affected. The process lasts for several years and goes through the stages of necrosis, fragmentation, recovery and outcome. The main danger is that the softened head can become deformed under load, and the abnormal shape of the joint will remain for life, leading to early coxarthrosis. The insidiousness of the disease is that the first sign is often not pain in the hip, but lameness and complaints about the knee. The earlier the diagnosis is made and the load regimen is selected, the higher the chance of maintaining the rounded shape of the head.

🧾 МКБ-10: M91.1 🏥 Where it is treated: 7 Most often boys 4–10 years oldPain radiates to the kneeThe shape of the femoral head is important

👨‍⚕️ Which doctor

Children's orthopedist, pediatrician

🔬 Diagnostics

X-ray of the pelvis in two projections, MRI of the hip joints, ultrasound of the joint

💊 Treatment

Unloading of the joint, orthoses and plaster casts, physical therapy, physiotherapy, in case of deformation - surgery

📈 Prognosis

In children under 6 years of age, usually good; the older the child and the larger the lesion, the higher the risk of deformation

⚠️ At risk

Male gender, age 4–10 years, short stature and delayed bone age, passive smoking, history of synovitis

⏱ When to see a doctor

Scheduled, but inspection cannot be postponed

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Ребёнок хромает больше двух недель или отказывается наступать на ногу
Боль в паху, бедре или колене, усиливающаяся к вечеру
Ограничение поворота и отведения ноги в тазобедренном суставе
Одна нога кажется короче другой, изменилась походка
Хромота с температурой, покраснением и отёком сустава — нужен срочный осмотр
Резкая боль после падения или прыжка на фоне уже имеющейся хромоты

What happens to the femoral head

The head of the femur in a child is fed by thin vessels running along the femoral neck. If blood flow through them is interrupted, the bone tissue under the cartilage dies. At the same time, the cartilage continues to receive nutrition from the joint fluid and remains alive, so the joint is not destroyed immediately. Then the body begins to resorb the dead bone and replace it with a new one - during this period the head is soft and easily flattens under the weight of the body. When the restructuring is completed, the shape of the head is finally fixed. That is why treatment is not aimed at “accelerating fusion”, but at protecting the head from stress during vulnerable months.

Stage of necrosis - death of bone tissue, complaints may be minimal
The fragmentation stage is the most vulnerable, the head is the easiest to deform
Recovery stage - growth of new bone
Outcome stage - the shape of the joint is fixed
The entire cycle usually takes from 2 to 4 years

Causes and risk factors

The exact cause of Perthes disease is unknown. They discuss the structural features of blood vessels in children of this age, repeated microtraumas, blood clotting disorders and the influence of external factors. The disease is not contagious and is not directly inherited, although it is more common in some families. It is important for parents to know: the disease does not occur due to “lack of calcium” and not because the child ran a lot, so the feeling of guilt is inappropriate here, but the implementation of the exercise regime really affects the outcome.

Ages 4–10 years, peak around 5–7 years
Boys get sick several times more often than girls
Delayed bone age and short stature
Passive smoking in the family
Repeated episodes of pain and synovitis in the joint
Blood clotting disorders (discussed as a factor)

Symptoms: what to look out for

The disease begins unnoticed. The child begins to limp, especially in the evening and after an active day, and the pain is often felt not in the hip, but in the knee - this is referred pain along the obturator nerve. Therefore, any long-term knee pain in a child should be checked along with the hip joint. Abduction and internal rotation of the leg are gradually limited, the muscles of the thigh and buttocks become thinner, and the leg may seem a little shorter.

Lameness that gets worse towards the end of the day
Pain in the knee, groin, or outer thigh
Limitation of hip abduction and internal rotation
Reduction in the volume of the thigh and buttock muscles
The child gets tired faster and asks to be held
Complaints either intensify or disappear completely for weeks

Diagnostics

The basis of the diagnosis is an x-ray of the pelvis in a direct projection and in the abduction position: it shows the stage of the process, the size of the affected area and the condition of the roof of the acetabulum. In the earliest stages, x-rays are normal, then MRI of the hip joints helps, which sees the area of impaired blood supply earlier. Ultrasound reveals joint effusion and helps distinguish Perthes disease from transient synovitis. Blood tests are needed to rule out infectious arthritis and inflammatory joint diseases.

X-ray of the pelvis in two projections, including the Lauenstein position
MRI of the hip joints in early and controversial cases
Ultrasound of the joint to assess effusion
Complete blood count and C-reactive protein if infection is suspected
Repeated images over time to control the stage

Treatment and prognosis

The goal of treatment is to keep the femoral head inside the acetabulum while it is soft and maintain joint mobility. In children under six years of age with minor lesions, observation, restriction of jumping and running, physical therapy and swimming are often sufficient. For larger lesions, abductor orthoses, plaster casts, traction are used, and for persistent deformity and limitation of movements, operations on the femur or pelvis are used. Painkillers and anti-inflammatory drugs are prescribed only by a doctor; you cannot give them to your child for a long time on your own. Observation continues until growth ends.

Limiting running, jumping and contact sports during illness
Physical therapy for abduction and rotation, swimming
Abduction orthoses and plaster casts according to indications
Physiotherapy and massage courses prescribed by an orthopedist
Surgical correction for severe deformity
Follow-up X-rays every few months

Services and prices for this diagnosis

Based on official price lists of Tashkent clinics. The exact cost is determined after examination.

🔬 Diagnostics

Первичная консультация педиатра Рентген костей таза (прямая проекция)from 200 000 Рентген тазобедренного сустава (прямая проекция)МРТ тазобедренных суставов УЗИ тазобедренного сустава (1 сустав)from 230 000

Frequently asked questions: Perthes disease (osteochondropathy of the femoral head)

Why does Perthes disease hurt the knee and not the hip?+

The hip and knee joints are partially innervated by the same nerves, so pain radiates from the hip to the knee. This is a classic trap: the child is treated for a long time for “knee problems” until they get an X-ray of the pelvis. Any persistent knee pain in a child requires examination of the hip joints.

Can a child with Perthes disease play sports?+

Running, jumping, football and contact sports are excluded during the illness, because the impact load deforms the softened head. Swimming and cycling without resistance are usually allowed and even recommended. The specific regimen is determined by the orthopedist based on the stage and extent of the lesion.

Do calcium and vitamins help cure Perthes disease?+

No. The disease is associated with impaired blood supply to the bone, and not with a lack of calcium. Nutrition should be complete, vitamin D is prescribed in case of deficiency, but supplements cannot replace joint unloading and observation by an orthopedist.

Will the limp last a lifetime?+

In children who become ill before the age of six, the head more often restores its rounded shape, and the function of the joint remains good. In children over eight years of age and when most of the head is affected, the risk of deformation and early arthrosis is higher. The prognosis is clarified by an orthopedist based on dynamic images.

Is surgery necessary for Perthes disease?+

Not always. Surgery is considered when the head extends beyond the socket, severe limitation of movement remains, or the child is older and the lesion is large. The decision is made based on radiographs and MRIs together with the parents, weighing the expected benefits.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated Perthes disease в Ташкенте

Хромота у ребёнка требует осмотра детского ортопеда и рентгена: под неё маскируются и транзиторный синовит, и юношеский эпифизеолиз, и инфекция сустава. Clinics Ташкента, где принимают детских ортопедов и делают рентген:

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