This pathology, known as Legg-Calve-Perthes or simply Perthes disease, is a hip disease that is often seen in children aged 4-10 years. The hip joint consists of the spherical head of the femur at the upper end of the thigh and a pelvic socket (acetabulum) that articulates with it and is compatible with the structure of the head.

In Perthes disease, the blood supply to the femoral head is interrupted for an unknown reason. In the following process, bone death (necrosis), bone softening and fractures occur in the ossification center of the femoral head. Dead bone areas are cleared over time; blood supply is rearranged and bone formation begins in these regions. In this process, the femoral head reshapes itself. The main factor that will determine the long-term fate of the hip in Pethes’ disease is how well this remodeling will be. The main purpose of the treatments described in the literature is to make the femoral head compatible with the pelvic socket as much as possible during the remodeling process. The better this fit, the better the long-term function of the hip joint.

It is known that the blood supply to the femoral head is interrupted in Perthes’ disease and then it recovers. The reason for the interruption of blood supply is unknown. A previous trauma or a disease that may cause vascular occlusion may lead to the development of Perthes disease. It is four times more common in boys than girls. Children with a family history of Perthes disease are at higher risk.

The most prominent complaint of the disease is pain radiating from the hip to the knee and limping in walking. Pain increases with physical activity and decreases with rest. When the patient is examined, it can be easily determined that there is a limitation of movement in the hip joint.

The diagnosis of the disease is made by evaluating the history, physical examination and radiological findings together. Most of the time, two-way direct hip radiography is sufficient for diagnosis. In the early stages of the disease, direct radiographic findings may not be revealed. During this period, magnetic resonance imaging (MRI) can be used for diagnostic purposes.

Radiological findings are important for the diagnosis as well as for the treatment plan. Radiological findings are guiding in making the surgical treatment decision and in classifying the disease.

Treatment

The patient’s age, examination and radiological findings are effective in the treatment of Perthes disease. Treatments can be grouped as surgical and non-surgical. The basic principle in the treatment of Perthes disease is to keep the femoral head in the pelvic socket and not to lose movement in the hip joint. For this purpose, surgical and conservative treatment methods can be used. Surgical treatment is rarely necessary in children under 6 years of age.

Among the non-surgical treatments, the most frequently recommended methods are drug therapy and physical therapy. Anti-inflammatory drug therapy helps to reduce the fluid increase and inflammation in the hip joint. The aim of physical therapy is to increase the mobility of the hip joint. For this reason, exercises that increase hip range of motion are emphasized in physical therapy.

Surgical treatments, soft tissue surgeries that help increase hip joint range of motion and engage the femoral head within the pelvic socket; It can be grouped as bone surgeries that direct the femoral head into the socket or increase the harmony of the hip joint by changing the shape of the pelvic socket. Depending on the age of the patient, the shape change in the femoral head and the structure of the pelvic socket, one of the bone surgeries may be preferred. If necessary, pelvic and thigh-sided bone surgeries can be applied together.

Perthes disease is a disease that follows certain processes after its onset and eventually heals by self-limiting. While most of the patients do not need surgical treatment, some patients require surgical treatments to provide more harmonious healing of the hip joint. Early detection of patients requiring surgical treatment and treatment with appropriate surgical methods are very important in terms of preserving hip functions.