Perthes disease

The diseases that can occur in childhood do not only include metabolic disorders or other health problems. The bone system can also be affected, so extensive treatment must be initiated. One of those bone diseases is Perthes disease.

What is Perthes disease?

With Perthes disease, those affected mainly suffer from pain. These can occur in different regions of the body and lead to severe impairments in the everyday life of the person concerned.
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A typical disease of the bone system is as Perthes disease designated damage. The disorders that occur in connection with Perthes' disease are locally limited to a special functional part of the thigh, the caput femoris.

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Perthes disease is what is known as aseptic necrosis of the bone. Aseptic in this context means death of the bone tissue that is not associated with infection.

As with Perthes' disease, bone necrosis occurs when bone cells are no longer functional and perish due to various causes. This process usually arises from the fact that the cell walls are destroyed, as is the case with Perthes' disease.

causes

In finding the causes for one Perthes disease it is important to categorize the triggers that lead to bone cell death.

These are only little known in this context and are likely to be based on an undersupply of the affected areas of the bone with blood. The technical term for this process is ischemia. In Perthes disease, this is limited to the head area of ​​the thigh, which actually holds the thigh in the hip joint. This zone is also supplied with blood like the entire bone.

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If this is not guaranteed, the cartilage cells and thus the head of the femur will break down. Unfortunately, it is currently not possible to determine the clear causes for the development of Perthes disease, so that the medical sciences still have to research it.

Symptoms, ailments & signs

Perthes disease is characterized by increasing joint and bone pain. The disease progresses in phases, whereby the symptoms can be divided into four stages. In the first stage, the affected children complain of pressing or throbbing pain in the knee and thighs. In the second stage, the affected leg can no longer be moved properly - the typical dragging when walking occurs.

Parents often describe these complaints as "laziness". In the third stage, the hip joint continues to degenerate and muscle wasting occurs. This is accompanied by chronic pain that persists during periods of rest. At this stage the patients limp a lot. This can lead to bullying and marginalization, which often leads to emotional problems.

Finally, the pain is so severe that the affected leg can no longer be moved. Perthes disease patients put themselves in a bad posture, which can result in joint wear and chronic pain. The symptoms of bone disease develop progressively, so they get worse and last longer. Typically, Perthes' disease sets in in early childhood. Outwardly, apart from the gait disorders, the disorder cannot be recognized.

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Diagnosis & course

Basically, the course of the Perthes disease characterized by an intermittent progression of the necrotic processes and is therefore divided into four stages.

Within these stages, the children experience painful discomfort in the thigh up to the knee and slight dragging of the affected leg when walking. With Perthes' disease, the children are often "lazy" and complain of pain in the groin. The mobility of the hip joint increases with Perthes disease and the muscle mass decreases significantly in this area.

The diagnosis of Perthes disease In addition to the visual assessment of the children by the specialist and the representation of the running motor skills, it includes a variety of imaging technologies. In addition to the X-ray image, computed tomography can be helpful in assessing the destruction of the bone structure in Perthes' disease.

Complications

With Perthes disease, those affected mainly suffer from pain. These can occur in different regions of the body and lead to severe impairments in the everyday life of the person concerned. This usually results in pain in the knees and hips. This can also result in restricted mobility, so that the patients limp and hobble.

Furthermore, due to Perthes' disease, a difference in leg lengths often occurs, which leads to gait disorders. Especially with children, the gait disorders can lead to bullying or teasing. If the pain also occurs at night, Perthes' disease can lead to sleep problems or depressive moods.

The everyday life of the person affected is significantly restricted and the patient's quality of life is considerably reduced by the disease. The treatment of this disease takes place with the help of physiotherapy and by taking pain medication. Furthermore, there is no reduction in life expectancy of the person affected. In many cases, surgery is also necessary so that a prosthesis can be inserted.

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When should you go to the doctor?

In Perthes disease, visits to the doctor are usually the beginning of a long series of consultations. The problem is that the symptoms of this circulation-related growth disorder are initially confused with other diseases or joint weaknesses and are misdiagnosed. In addition, the symptoms in the affected children are not uniform. The individual symptoms of Perhes' disease are difficult to assess, especially in the early stages.

In the second stage of the disease, Perthes disease is usually correctly diagnosed. Since the increasing symptoms are cause for concern in many cases, parents should consult an orthopedic surgeon as soon as their child develops unilateral leg problems, relieving postures or expressions of pain. Whether the present complaints require treatment or whether the matter grows out over time is different. Often the affected joints only need to be spared.

It is often useful to get a second opinion. For severe joint problems, some doctors want to prescribe pain relievers. The question is, however, whether it is actually Perthes' disease or just a temporary runny nose. If the diagnosis of Perthes disease is confirmed, there is no alternative to suitable treatment with regular follow-up examinations due to the possible damage to the joints.

Depending on the state of the disease and symptoms, the attending physician can decide between conservative or surgical therapy. The aim of therapy is to prevent the affected joint from being destroyed.

Treatment & Therapy

Since the disease Perthes disease by individually deviating course forms, the therapy is also different. Depending on the age of the patient and the extent of the necrotic processes, drug and surgical procedures are used in a treatment in addition to conventional, conservative therapy.

Conservative therapy for Perthes disease includes relieving the pressure on the thighs and hips with a special splint, fitting a plaster cast or a so-called Synder Sling or orthoses. Extension treatment and walking aids are also common.

Pain relievers and nonsteroidal anti-inflammatory drugs such as ibuprofen are prescribed as drugs for Perthes disease during the acute stages. Surgical interventions are useful in Perthes disease when it comes to maintaining an artificial femoral head.

Several surgical procedures are implemented in practice, which are represented by an erection of the femoral neck, a "pivoting" of the roof of the joint socket or an artificial paralysis of parts of the thigh muscles with Botox.

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Outlook & forecast

As a rule, a scientifically justifiable prognosis cannot be made for Perthes disease. However, it depends heavily on the quality of the existing congruence or incongruence between the two joint surfaces after healing. At the end of growth, the doctor can usually make a prognosis based on the shape of the femoral head. The more spherical the femoral head and the more congruent it is to the acetabulum, i.e. the more precise the fit between the two joint bodies, the better the prognosis.

Aspherical congruence, in which the joint partners adapt, is associated with an increased risk of hip arthrosis (coxarthrosis). As a rule, this only shows up after the age of 50. If there is an incongruence, hip arthrosis usually develops faster. A severe deformation is also associated with further joint damage, increasing limitations in joint mobility and pain. The onset of the disease at a later age is also unfavorable for the prognosis.

Compared to older children, young children have a better potential for regeneration. Therefore, the prognosis for children who developed the disease before the age of 5 is mostly very good. If left untreated or treated too late, Perthes' disease leads to irreversible (irreversible) hip deformity and possibly to pronounced joint wear and tear even at a young age.

prevention

Unfortunately, there is currently no prevention against Perthes disease possible. However, the following facts should say something about the prognosis of Perthes' disease: The sooner a treatment starts and the younger the children are, the better the prospect that a deformation of the femoral head can be reduced.

In most cases, the chances of surgical repair of the hip and thigh joint are particularly good. Due to the progressive course of Perthes' disease, which has not yet been stopped, the implantation of a high-quality artificial joint is usually unavoidable in order to achieve a corresponding quality of life.

Aftercare

Perthes disease requires extensive follow-up care. After the treatment of the condition has been completed, the sick children need physiotherapeutic care. As part of physiotherapy, the joints are mobilized in order to expand the range of motion in the long term. This is usually done using forearm crutches. Follow-up care usually lasts twelve weeks.

In the first six weeks, for example, the femoral head is fully relieved. In the second six weeks, there is a partial load using the so-called 4-point gait. Which measures are necessary in detail and over what period of time they must be carried out depends on the severity of Perthes' disease.

The responsible physiotherapist prepares the aftercare together with the attending physician and the patient. After Perthes disease has been cured and mobility has been optimized, extensive follow-up care is no longer necessary. The child needs regular medical examinations. Typical measures such as x-rays or ultrasound are used here.

In addition, checking and, if necessary, adjusting the child's pain medication is part of the follow-up. Parents of affected children should discuss follow-up care with their doctor at an early stage so that therapy can continue seamlessly after the operation.

You can do that yourself

Children with Perthes disease need support in everyday life. Depending on the severity of the disease, those affected are dependent on walking aids, wheelchairs and other aids in order to be able to move about everyday without symptoms. The sick are usually not allowed to do sports. Above all, sports that put stress on the hips should be avoided.

Despite these measures, several operations must be performed, often over a period of several years, as the disease progresses. The repeated interventions as well as the suffering itself often stress those affected emotionally. This makes it all the more important to deal openly with the disease. The parents should inform the child about the symptoms and the severity of the condition at an early stage and go to a specialist clinic with the child or speak to an orthopedic surgeon. The necessary psychosocial care is offered within the framework of self-help groups, in which everyday problems can be discussed and experiences can be exchanged.

Self-help also includes compliance with medical guidelines after treatment. For example, the prescribed pain relievers must be taken as prescribed to minimize the risk of side effects and interactions.