Perthes disease (summary)

This is a basic article for medical students and other non-radiologists

Perthes disease is the name given to idiopathic AVN (avascular necrosis)osteonecrosis of the femoral epiphysis in children. It most often occurs in children around the age of 5-6 years and is one of the common considerations when children present with an atraumatic limp or hip pain.

Reference article

This is a summary article. For more information, you can read a more in-depth reference article: Perthes disease.

Summary

• epidemiology

  • 5-15/100,000

  • 5 times more boys than girls

  • peak presentation at 5-6 years (CI 2-14 years)

• presentation

  • atraumatic hip pain or limp

  • may be coincidental history of trauma (precipitates presentation)

• pathology

  • lack of blood supply to the femoral head

  • fragmentation and bone loss

  • 15% of cases are bilateral

  • cause of AVNosteonecrosis in Perthes disease inis unclear

• radiology

  • pelvic radiograph for assessment and diagnosis

  • MRI for persistent pain in children with normal radiographs

  • US may detect an effusion, but is not sensitive for AVNosteonecrosis

• treatment

  • symptom control in the early phase

  • degeneration as the disease progresses may require operative management

Radiographic features

Plain radiograph

The radiographic changes to the femoral epiphyses depend on the severity of AVNosteonecrosis and the amount of time that there has been alteration of blood supply:

• early: there may be no appreciable change

• established: reduction in epiphysis size, lucency

• late: fragmentation, destruction

As changes progress, the width of the femoral neck increases (coxa magna) in order to increase weight-bearing support.

MRI

On MRI, we are looking forthere is typically bone oedema and evidence of an effusion. Bone oedema will be bright on fluid-weighted sequences, e.g. T2/STIR.