Management of Perthes' Disease

Abstract

Legg- Calve-Perthes' disease is a self limiting condition ofthe•hip that leads to variable degree of deformity and restricted motion of the joint. It affects boys more than girls, usually between three and eight years of age. Occasionally the disease comes bilateral. Despite much research in the aetiology, pathology and methods of treatment, the casuse ofPerthes' disease remain unsolved and the treatment therefore remain empirical. It is now generally accepted that the major underlaying process is that of avascular necrosis of the upper femoral epiphysis. Pathologically, the condition is characterized by avascular necrosis of the capital femoral ossification center, which is ultimatley resorbed and replaced by new bone. By the end of the disease capital, cervical and acetabular deformities are usual in severe cases. Initially, there is an ischaemic episodes of unknown aetiology that renders most if not all the capital femoral epiphysis avascular. Endochondrial ossification in the preosseous epiphyseal cartilage and physeal plate ceases temporarly while the articlar cartilage being nourished continue to grow. This result in the radiographic appearance of widened medial joint space and smaller ossific nucleus of the involved hip this is the first radiographic manifestation. The marrow space of the epiphysis is necrotic, revascularization of the structurally intact but avascular capital epiphysis occures from the periphery and progress centrally.