Based on diagnostic suspicion and radiological confirmation.

  • a. During the consultation, a comprehensive assessment of the degree of clinical involvement of the child, and more specifically of the hip, should be performed by a thorough examination.
  • b. The definitive diagnosis is based specifically on the hip radiology:
  • Radiography in two projections: It is usually the only test to be performed.
  • MRI or Magnetic Resonance Imaging: test that detects the disease earlier. Although it is rarely used for this purpose.
Caso-de-Perthes-en-la-cadera-izquierda-en-un-niño-de-9-años

The radiographic alteration may take a few days or weeks to appear. In this case it is advisable to repeat the X-ray a month after the previous one, or to perform an MRI.

If you have any diagnostic concerns, ask for an appointment on-line right now.

Radiology images will show us the phase in which the disease is, because it is common that the actual onset has occurred long before any onset of symptoms.

In our experience more than 10% of the cases did not show initial symptoms.

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Perthes Disease

DURATION OF THE DISEASE: 6,1 YEARS

FOUR PHASES:

necrosis

After the loss of blood supply, the cells of the femoral head die, bone necrosis. The cells maintain the bone structure and lie between the mesh of proteins as niches.

After their death, more or less intense crushing of the bone begins, due to loss of structural maintenance.

The initial deformity that appears can bereversed if we act early.

BE PROACTIVE AND TREAT, DO NOT WAIT.

DURATION: 6 months on average.

Initial phase:

  • Pain and lameness.
  • Sometimes asymptomatic.
RADIOGRAPHY OF HIP: X-ray usually shows a sclerotic epiphysis and somewhat flattened. In the x-ray the bone appears whiter and more intense. Necrotic bone is compacted and appears more dense, in a white mass..

fase de fragmentación

Once the bone loses the bone cells or “bone maintenance workers”, the structure or scaffold of the bone collapses.

This scaffold or mesh is made up of proteins and minerals that form the structure.

Now the crushing of the bone continues, but also the reabsorption of the dead tissue begins, by other cells that arrive via the blood.

There will be areas of dead bone and other areas already cleaned. That is why the radiographic aspect is mottled.

THE MOST PLASTIC PHASE OF THE FEMORAL HEAD. It is the best moment for the treatment in cases of the head at risk.

THE BEST SURGICAL THERAPEUTIC WINDOW.

It is the best time to treat if necessary, especially in heads at risk.

BE PROACTIVE AND TREAT. DO NOT WAIT.

DURATION: 7 months on average.

RADIOGRAPHY OF THE HIP: a femoral head appears with white areas next to black areas. Sign of necrosis and resorption of dead bone. Mottled appearance of the hip.

HEAD AT RISK: these are signs that indicate the need to operate if we want to have a good final result.

ANALYZE WITH THE TRAFFIC LIGHT TOOL the situation of risk of the hip.

reosificación

Onset when bone tissue reappears after the arrival of new blood channels.

It is usually already present from the 14th month from the beginning of this process.

It is the longest lasting phase, about 60 months on average. Bone deformities are already established, but can still be reversed and have good results.

TREATMENT BEFORE THIS PHASE IS IMPORTANT in cases of “femoral head at risk”.

Areas of new bone appear where there was none. This new bone is called “osteoid” and is first determined in the external column and in the subchondral bone, that is to say, the bone under the articular cartilage.

In some cases subluxation of the hip also appears, in which case it MUST BE TREATED surgically. It is called “head at risk” and if not treated, it will suffer intense deformity and final osteoarthritis at an early age.

ANALYZE WITH THE TRAFFIC LIGHT TOOL the risk of the hip.

BE PROACTIVE AND DO NOT WAIT

remodelación

In this phase the Perthes has healed. The femoral head is already of normal density. Bone deformities are visible and stable.

THE BONY DEFORMITIES ARE ALREADY DEFINITIVE.

CARTILAGINOUS DEFORMITIES MAY CONTINUE TO PROGRESS.

The patient should be monitored until the end of their growth.

Growth disturbances of the femur are the norm and cannot be ignored.

Follow-up by your perthes specialist is essential until growth is complete.

Remodeling image: The femoral head is already of normal density and with residual bone deformities. It is mandatory to monitor the evolution of the deformity: Ovalization process.

In 40% of cases an oval head will occur. Avoid it.

In addition, the frequent occurrence of difference in the length of the lower limbs should be monitored.

ANALYZE WITH THE TRAFFIC LIGHT TOOL THE RISK OF HIP OVALIZATION.

BE PROACTIVE AND DO NOT WAIT