The diseases that can occur in childhood include not only metabolic disorders or other health impairments. The bone system can also be affected, so that extensive treatment must be initiated. One of these bone diseases is Perthes disease.
What is Perthes disease?
A typical disease of the bone system is the damage known as Perthes disease. The disorders that occur in connection with Perthes’ disease are locally limited to a special functional part of the thigh, the caput femoris. See growtheology for Comprehensive Guide to Indirect Ocular Trauma.
Perthes disease is a so-called aseptic necrosis of the bone. Aseptic in this context means death of bone tissue not associated with infection.
Bone necrosis occurs, as in Perthes’ disease, when bone cells are no longer functional and perish due to various causes. As a rule, this process arises from the fact that the cell walls are destroyed, as is the case with Perthes disease.
Causes
When finding the causes of Perthes ‘ disease, it is important to categorize the triggers that lead to the death of bone cells.
Little is known about these in this context and they are probably based on an undersupply of blood to the affected areas of the bone. The technical term for this process is ischemia. In Perthes’ disease, this is limited to the head area of the thigh, which actually holds the thigh in the hip joint. This zone is also supplied with blood like the entire bone.
If this is not guaranteed, the cartilage cells and thus the femoral head degrade. Unfortunately, it is currently not yet possible to determine the clear causes of the development of Perthes’ disease, so that medical science still has to do research on it.
Symptoms, Ailments & Signs
Perthes disease is characterized by increasing joint and bone pain. The disease progresses in phases, and the symptoms can be divided into four stages. In the first stage, the affected children complain of oppressive or throbbing pain in their knees and thighs. In the second stage, the affected leg can no longer be moved properly – the typical dragging when walking occurs.
Parents often describe these complaints as “lazy to run”. In the third stage, the hip joint continues to degenerate and muscle atrophy occurs. This is accompanied by chronic pain that persists during periods of rest. Patients are already limping badly at this stage. This can lead to bullying and exclusion, which often results in psychological problems.
Finally, the pain is so severe that the affected leg can no longer be moved. As a result, Perthes disease patients adopt a poor posture, which can result in joint wear and tear and chronic pain, among other things. Symptoms of bone disease are progressive, meaning they get worse and last longer. Typically, Perthes’ disease sets in in early childhood. Externally, apart from the gait disturbances, the disorder is not recognizable.
Diagnosis & History
Basically, the course of Perthes ‘ disease is characterized by a gradual progression of the necrotic processes and is therefore divided into four stages.
Within these stages, the children experience painful discomfort from the thigh to the knee and a slight dragging of the affected leg when walking. The children with Perthes’ disease are often “lazy to walk” and complain about pain in the groin. The mobility of the hip joint increases with Perthes disease and the muscle mass decreases significantly in this area.
The diagnosis of Morbus Perthes includes a variety of imaging technologies in addition to the visual assessment of the children by the specialist and the display of the motor skills. In addition to the X-ray image, computer tomography can be helpful here in order to assess the destruction of the bone structure in Perthes disease.
Complications
Those affected suffer primarily from pain as a result of Perthes’ disease. These can occur in different regions of the body and lead to severe impairments in the everyday life of those affected. This usually causes pain in the knees and hips. This can also result in movement restrictions, so that the patients limp and limp.
Furthermore, a difference in leg lengths often occurs due to Perthes’ disease, which results in gait disorders. Children in particular can be bullied or teased because of the gait disorders. If the pain also occurs at night, Perthes’ disease can lead to sleep disorders or depressive moods.
The everyday life of those affected is significantly restricted and the patient’s quality of life is significantly reduced by the disease. The treatment of this disease takes place with the help of physiotherapy and the use of painkillers. Furthermore, there is no reduction in the life expectancy of those affected. In many cases, an operation is also necessary so that a prosthesis can be fitted.
When should you go to the doctor?
Visits to the doctor are usually at the beginning of a longer series of consultations in Perthes disease. The problem is that the symptoms of this circulatory-related growth disorder are initially confused with other diseases or joint weaknesses and misdiagnosed. In addition, the symptoms in the affected children are not uniform. The individual symptoms of Perhes disease are difficult to assess, especially in the early stages.
In the second stage of the disease, Perthes’ disease is usually correctly diagnosed. Since the increasing symptoms give cause for concern in many cases, parents should consult an orthopedist as soon as their child develops one-sided leg problems, relieving posture or expressions of pain. Whether the existing complaints require treatment or whether the matter grows out over time is different. Often the affected joints only have to be protected.
It often makes sense to get a second opinion. Some doctors want to prescribe painkillers for severe joint problems. But the question is whether it is actually Perthes’ disease or just a temporary hip cold. If the diagnosis of Perthes’ disease is confirmed, there is no alternative to suitable treatment with regular follow-up examinations because of the possible joint damage.
Depending on the status of the disease and the symptoms, the doctor treating you can decide between conservative or surgical therapy. The aim of therapy is to prevent the destruction of the affected joint.
Treatment & Therapy
Since the disease Perthes disease is represented by individually different forms of progression, the therapy is also different. Depending on the age of the patient and the extent of the necrotic processes, drug and surgical procedures are used in one treatment in addition to conventional, conservative therapy.
Conservative therapy for Perthes’ disease includes relieving the thigh and hip with a special splint, the adjustment of a plaster support bandage or a so-called Synder Sling or orthoses. Extension treatment and walking aids are also common.
Painkillers and non-steroidal anti- inflammatory drugs such as ibuprofen are prescribed as medications for Perthes disease during the acute stages. Surgical interventions are useful in Perthes’ disease when it comes to obtaining an artificial femoral head.
Several surgical procedures are implemented in practice, which are represented by raising the neck of the femur, “pivoting” the roof of the joint socket or by artificially paralyzing parts of the thigh muscles with Botox.
Outlook & Forecast
As a rule, a scientifically justifiable prognosis cannot be made for Perthes disease. However, it depends heavily on the quality of the existing congruence or incongruity between the two articular surfaces after healing. In most cases, the doctor can make a prognosis at the end of growth based on the shape of the femoral head. The more spherical the femoral head and the more congruent it is to the hip socket, i.e. the more exact the fit between the two joint bodies, the better the prognosis.
Aspherical congruence, in which the joint partners adapt, is associated with an increased risk of hip joint arthrosis (coxarthrosis). As a rule, however, this only becomes apparent after the age of 50. If there is an incongruity, osteoarthritis of the hip usually develops more quickly. Severe deformation is also associated with further joint damage, increasing limitations in joint mobility and pain. The onset of the disease at a later age is also prognostically unfavorable.
Young children have a better potential for regeneration than older ones. The prognosis for children who developed the disease before the age of 5 years is therefore very good in the majority. If left untreated or treated too late, Perthes disease leads to irreversible (irreversible) hip deformation and possibly to pronounced joint wear and tear at a young age.
Prevention
Unfortunately, it is currently not possible to prevent Perthes ‘ disease. However, the following facts should say something about the prognosis of Perthes’ disease: The sooner treatment begins and the younger the children are, the better the prognosis that deformation of the femoral head can be reduced.
In most cases, the chances of surgical repair of the hip and thigh joint in particular are good. Due to the progressive course of Perthes’ disease, which cannot yet be stopped, the implantation of a high-quality artificial joint is usually unavoidable in order to ensure a corresponding quality of life.
Aftercare
Perthes disease requires extensive follow-up care. After the treatment of the condition has been completed, the sick children require physiotherapeutic care. As part of physiotherapy, the joints are mobilized in order to increase the range of motion in the long term. This is usually done using forearm crutches. Follow-up care usually lasts twelve weeks.
In the first six weeks, for example, the femoral head is fully relieved. In the second six weeks, a partial load is carried out using the so-called 4-point gait. Which measures are necessary in detail and over what period of time these must be carried out depends on the severity of the Perthes disease.
The responsible physiotherapist prepares the follow-up care together with the attending doctor and the patient. After Perthes’ disease has been cured and mobility has been optimized, comprehensive follow-up care is no longer necessary. The child must be regularly examined by a doctor. Typical measures such as X-rays or ultrasound are used here.
In addition, checking and, if necessary, adjusting the child’s pain medication is part of the aftercare. Parents of affected children should discuss follow-up care with the doctor at an early stage so that the therapy can be continued seamlessly after the operation.
You can do that yourself
Children suffering from Perthes’ disease need support in everyday life. Depending on the severity of the disease, those affected are dependent on walking aids, wheelchairs and other aids in order to be able to move around in everyday life without symptoms. Patients are usually not allowed to do any sports. In particular, sports that put stress on the hips should be avoided.
Despite these measures, several surgeries have to be performed, often over a period of several years, as the disease progresses progressively. The repeated interventions as well as the suffering itself often put a psychological strain on those affected. It is all the more important to deal openly with the disease. The parents should inform the child at an early stage about the symptoms and the extent of the condition and take the child to a specialist clinic or speak to an orthopaedist. The necessary psychosocial care is offered within the framework of self-help groups, in which everyday problems can be discussed and experiences exchanged.
Self-help also includes adhering to the medical requirements after treatment. For example, the prescribed painkillers must be taken as directed to minimize the risk of side effects and interactions.
