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Review
. 2009 Jul;106(31-32):517-23.
doi: 10.3238/arztebl.2009.0517. Epub 2009 Aug 3.

Perthes disease: current principles of diagnosis and treatment

Manfred Nelitz  1 , Sabine Lippacher, Rüdiger Krauspe, Heiko Reichel
Affiliations
Review

Perthes disease: current principles of diagnosis and treatment

Manfred Nelitz et al. Dtsch Arztebl Int. 2009 Jul.

Abstract

Background: Because the course of Legg-Calvé-Perthes disease (LCPD) is highly variable, its appropriate diagnostic evaluation and treatment are still debated.

Methods: The authors selectively review the literature, present their own study findings, and discuss the guidelines of the German Society for Orthopedics and Orthopedic Surgery.

Results: The main prognostic factors are the patient's age at the onset of the disease, the degree of limitation of range of motion, the extent of involvement of the femoral epiphysis, and any additional radiographic "head-at-risk" signs. Depending on the severity of the disease, the treatment options range from observation and frequent follow-up to reconstructive hip surgery. The goal of all treatments is to prevent a prearthrotic deformity and the ensuing premature coxarthrosis. This goal is best met by adherence to the principle of containment, i.e., the maintenance or restoration of joint congruence while biological plasticity is still present.

Conclusions: In view of the variable course of LCPD, the proper course of treatment must be determined individually in each case. Every child with LCPD must receive individually adapted treatment and continued follow-up into adulthood.

Keywords: Legg-Calvé-Perthes disease; joint diagnosis; osteochondrosis; pediatric disease; prognosis.

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Figures

Figure 1
Figure 1
Herring’s "lateral pillar" classification, depending on the height of the lateral pillar (necrotic area marked in red)
Figure 2
Figure 2
Involvement of the entire epiphysis, with the height of the lateral pillar less than half normal (Herring type C, Catterall type IV). In addition, note lateralization (arrow) and metaphyseal cysts, both of which are "head-at-risk" signs.
Figure 3
Figure 3
Treatment algorithm for Perthes disease, depending on the patient’s age and risk factors
Figure 4
Figure 4
Restoration of containment by means of varus osteotomy (left) or Salter’s pelvic osteotomy (right), after "hinge abduction" has been ruled out intraoperatively
Figure 5
Figure 5
Treatment of a short femoral neck and high trochanter with osteotomy and lengthening of the femoral neck
See this image and copyright information in PMC

Comment in

  • Alternative to crutches?
    Heimkes B. Heimkes B. Dtsch Arztebl Int. 2010 Jan;107(4):62; author reply 62. doi: 10.3238/arztebl.2010.0062a. Epub 2010 Jan 29. Dtsch Arztebl Int. 2010. PMID: 20165709 Free PMC article. No abstract available.

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