Literatur

Die Literatur zum Morbus Perthes ist umfangreich. Eine Recherche bei PubMed für „perthes disease“ ergibt 2552 Treffer (Sept. 2020).

Versuch einer Auswahl

Calvé J. Sur une forme particulière de pseudo-coxalgie greffée sur des déformations caractéristiques de l’extrémité supérieure du fémur. Revue de chirurgie. 1910, 42:54–84.

Legg A. An obscure affection of the hip joint. Boston Medical and Surgical Journal. 1910, 162:202–204. https://www.nejm.org/doi/full/10.1056/NEJM191002171620702.- Legg AT. An obscure affection of the hip joint. 1910. Clin Orthop Relat Res. 2006;451:11-13. https://pubmed.ncbi.nlm.nih.gov/17038923/

Perthes GC. Über Arthritis deformans juvenilis. Deutsche Zeitschrift für Chirurgie. 1910, 107:111–159.

Waldenström, H. Der obere tuberkulöse Collumherd. Zeitschrift für orthopädische Chirurgie 1909;XXIV:487-512

AXER A. SUBTROCHANTERIC OSTEOTOMY IN THE TREATMENT OF PERTHES‘ DISEASE: A PRELIMINARY REPORT. J Bone Joint Surg Br. 1965 Aug;47:489-99. https://pubmed.ncbi.nlm.nih.gov/14341066/

Canavese F, Dimeglio A. Perthes‘ disease: prognosis in children under six years of age. J Bone Joint Surg Br. 2008 Jul;90(7):940-5. https://pubmed.ncbi.nlm.nih.gov/18591607/

Caffey JP. The early roentgenographic changes in essential coxa plana: their significance in pathogenesis. Am J Roentgen 1968;103:620-34.

Catterall A. The natural history of Perthes‘ disease. J Bone Joint Surg Br. 1971;53(1):37‐53. https://pubmed.ncbi.nlm.nih.gov/5578764/?from_term=Catterall+Natural+History+Perthes%27+Disease

Catterall A. Legg-Calvé-Perthes syndrome. Clin Orthop Relat Res. 1981;(158):41‐52. https://pubmed.ncbi.nlm.nih.gov/7023775/?from_term=Catteral+Legg-Calv%C3%A9-Perthes

Catterall A. Legg-Calvé-Perthes‘ disease. Current problems in orthopaedics. Churchill Livingstone; Edinburgh, London, Melbourne, New York, 1982a.

Coates CJ, Paterson JM, Woods KR, Catterall A, Fixsen JA. Femoral osteotomy in Perthes‘ disease. Results at maturity. J Bone Joint Surg Br. 1990 Jul;72(4):581-5. https://pubmed.ncbi.nlm.nih.gov/2380208/

Conway JJ. A scintigraphic classification of Legg-Calvé-Perthes disease. Semin Nucl Med. 1993 Oct;23(4):274-95. https://pubmed.ncbi.nlm.nih.gov/8256137/

Joseph B, Varghese G, Mulpuri K, Narasimha Rao K, Nair NS. Natural evolution of Perthes disease: a study of 610 children under 12 years of age at disease onset. J Pediatr Orthop. 2003;23(5):590‐600. https://pubmed.ncbi.nlm.nih.gov/12960621/?from_single_result=Joseph+B.+Natural+Evolution+of+Perthes+Disease.+-+A+Study+of+610+Children+Under+12+Years

Lloyd-Roberts GC. The management of Perthes‘ disease. J Bone Joint Surg Br. 1982;64(1):1-2. https://pubmed.ncbi.nlm.nih.gov/7068710/

Petrie JG, Bitenc I. The abduction weight-bearing treatment in Legg-Perthes‘ disease. J Bone Joint Surg Br. 1971 Feb;53(1):54-62. https://pubmed.ncbi.nlm.nih.gov/5578766/

Salter RB, Thompson GH. Legg-Calvé-Perthes disease. The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am. 1984 Apr;66(4):479-89. https://pubmed.ncbi.nlm.nih.gov/6707027/

Salter RB. The present status of surgical treatment for Legg-Perthes disease. J Bone Joint Surg Am. 1984 Jul;66(6):961-6. https://pubmed.ncbi.nlm.nih.gov/6736099/

Soeur S, De Racker Ch. L’aspect anatomopathologique de l’ostéochondrite et les théories pathogéniques qui s’y rapportent. Acta Orthopaedica Belgica, 1952;18(2),57-102 https://pubmed.ncbi.nlm.nih.gov/14932925/

Stanitski CL. Hip range of motion in Perthes‘ disease: comparison of pre-operative and intra-operative values. J Child Orthop. 2007 Mar;1(1):33-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656703/

Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63(7):1095‐1108. https://pubmed.ncbi.nlm.nih.gov/7276045/?from_term=Stulberg+Cooperman+perthes&from_pos=2

Neyt JG, Weinstein SL, Spratt KF, Dolan L, Morcuende J, Dietz FR, Guyton G, Hart R, Kraut MS, Lervick G, Pardubsky P, Saterbak A. Stulberg classification system for evaluation of Legg-Calvé-Perthes disease: intra-rater and inter-rater reliability. J Bone Joint Surg Am. 1999 Sep;81(9):1209-16. https://pubmed.ncbi.nlm.nih.gov/10505517/

Traina F, De Fine M, Sudanese A, Calderoni PP, Tassinari E, Toni A. Long-term results of total hip replacement in patients with Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 2011;93(7):e25. https://pubmed.ncbi.nlm.nih.gov/21471405/

Wiig O, Terjesen T, Svenningsen S. Inter-observer reliability of the Stulberg classification in the assessment of Perthes disease. J Child Orthop. 2007 Jul;1(2):101-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656716/pdf/

Waldenström, H. The definite Form of the Coxa Plana. Acta radiologica Vol. I. 1922;31:384-94.

Waldenström, H. On Coxa Plana. Osteochondritis deformans coxae iuvenilis. Legg’s disease. Maladie de Calvé. Acta chir. Scandinav. 1923;55:577-90.

Konservative Behandlung (Schonung, unloading, Schrittzähler, Gips, Orthesen, Bettruhe …)

Lauritzen J. Legg-calvé-perthes disease. Acta Orthop Scand Suppl. 1975;159:1-137. https://www.tandfonline.com/doi/abs/10.3109/ort.1975.46.suppl-159.01

Meiss L. Perthes – aggressives Zuwarten versus schonende Operation, „Kontroverses in der Kinderorthopädie“, Kongreßband anläßlich des Münsteraner Frühjahrs-Symposiums, Isabel Hoffstetter (Hrsg.), 13./14. Mai 1994.

Rich MM, Schoenecker PL. Management of Legg-Calvé-Perthes disease using an A-frame orthosis and hip range of motion: a 25-year experience. J Pediatr Orthop. 2013 Mar;33(2):112-9. https://pubmed.ncbi.nlm.nih.gov/23389562/

Peck JB, Greenhill DA, Morris WZ, Do DH, McGuire MF, Kim HKW. Prolonged non-weightbearing treatment decreases femoral head deformity compared to symptomatic treatment in the initial stage of Legg-Calvé-Perthes disease. J Pediatr Orthop B. 2021 May 20. https://pubmed.ncbi.nlm.nih.gov/34028380/

Modified Elizabethtown Classification

Canale ST, D’Anca AF, Cotler JM, Snedden HE. Elizabethtown, Pennsylvania. Innominate osteotomy in Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1972;54(1):25-40.

Hyman JE, Trupia EP, Wright ML, et al. Interobserver and intraobserver reliability of the modified Waldenström classification system for staging of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 2015;97(8):643‐650. https://pubmed.ncbi.nlm.nih.gov/25878308/?from_single_result=Hyman+JE+et+al.+Modified+Waldenstro%CC%88m+Classification+System+for+Staging+of+LCPD

Histologie

Jonsäter S. Coxa plana: a histo-pathologic and arthrographic study. Acta Orthop. Scand., Suppl. 12, 1953.

Larsen EH & Reimann I (1973) Calvé Perthes Disease: With special reference to histological observations, Acta Orthopaedica Scandinavica, 44:4-5, 426-438. https://doi.org/10.3109/17453677308989078

Catterall A, Pringle J, Byers PD, et al. A review of the morphology of Perthes‘ disease. J Bone Joint Surg Br. 1982;64(3):269-275. https://pubmed.ncbi.nlm.nih.gov/6807991/

Catterall A, Pringle J, Byers PD, Fulford GE, Kemp HB. Perthes‘ disease: is the epiphysial infarction complete?. J Bone Joint Surg Br. 1982;64(3):276-281. https://pubmed.ncbi.nlm.nih.gov/7096391/

Catterall A. Legg-Calvé-Perthes‘ disease. Current problems in orthopaedics. Churchill Livingstone; Edinburgh, London, Melbourne, New York, 1982a.

Kim HK. Pathophysiology and new strategies for the treatment of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 2012 Apr 4;94(7):659-69. https://pubmed.ncbi.nlm.nih.gov/22488623/

MRT – Magnetresonanztomographie, Kernspintomographie

de Sanctis N, Rega AN, Rondinella F. Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part I: the role of physeal involvement. J Pediatr Orthop. 2000 Jul-Aug;20(4):455-62. https://pubmed.ncbi.nlm.nih.gov/10912600/

de Sanctis N, Rondinella F. Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part II: pathomorphogenesis and new classification. J Pediatr Orthop. 2000 Jul-Aug;20(4):463-70. https://pubmed.ncbi.nlm.nih.gov/10912601/

Dillman JR, Hernandez RJ. MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol. 2009 Nov;193(5):1394-407. https://pubmed.ncbi.nlm.nih.gov/19843759/

Upright-MRT

Aarvold A, Lohre R, Chhina H, Mulpuri K, Cooper A. Dynamic deformation of the femoral head occurs on weightbearing in Legg-Calves-Perthes disease: a translational pilot study. Bone Jt Open. 2020 Nov 2;1(7):364-369. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659704/

Implantat für die proximale Femurosteotomie (PFO, IVO)

LCP Pediatric HipPlate. http://synthes.vo.llnwd.net/o16/LLNWMB8/INT%20Mobile/Synthes%20International/Product%20Support%20Material/legacy_Synthes_PDF/DSEM-TRM-0814-0181-2_LR.pdf

Sagging rope sign

Apley AG, Wientroub S. The sagging rope sign in Perthes‘ disease and allied disorders. J Bone Joint Surg Br. 1981 Feb;63-B(1):43-7. https://pubmed.ncbi.nlm.nih.gov/7204473/

Clarke NM, Harrison MH, Keret D. The sagging rope sign: a critical appraisal. J Bone Joint Surg Br. 1983 May;65(3):285-7. https://pubmed.ncbi.nlm.nih.gov/6841397/ https://www.researchgate.net/publication/16358417_The_sagging_rope_sign_A_critical_appraisal/link/55753f0508ae7536374ff7e0/download

Kim HT, Eisenhauer E, Wenger DR. The „sagging rope sign“ in avascular necrosis in children’s hip diseases–confirmation by 3D CT studies. Iowa Orthop J. 1995;15:101-11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2329075/pdf/iowaorthj00019-0126.pdf

Beinlängendifferenz

Grzegorzewski A, Synder M, Kozłowski P, Szymczak W, Bowen RJ. Leg length discrepancy in Legg-Calve-Perthes disease. J Pediatr Orthop. 2005 Mar-Apr;25(2):206-9. https://pubmed.ncbi.nlm.nih.gov/15718903/

Trochanterhochstand, T.-apophyseodese

Langenskiöld A. Changes in the capital growth plate and the proximal femoral metaphysis in Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 1980 Jul-Aug;(150):110-4. https://pubmed.ncbi.nlm.nih.gov/7428207/

Shah H, Siddesh ND, Joseph B, Nair SN. Effect of prophylactic trochanteric epiphyseodesis in older children with Perthes‘ disease. J Pediatr Orthop. 2009 Dec;29(8):889-95. https://pubmed.ncbi.nlm.nih.gov/19934705/

Haskel JD, Feder OI, Mijares J, Castañeda P. Isolated Trochanteric Descent and Greater Trochanteric Apophyseodesis Are Not Effective in the Treatment of Post-Perthes Deformity. Clin Orthop Relat Res. 2020 Jan;478(1):169-175. https://pubmed.ncbi.nlm.nih.gov/31725028/

Seltene späte Komplikation: Osteochondrosis dissecans (OD)

Lamplot JD, Schoenecker PL, Pascual-Garrido C, Nepple JJ, Clohisy JC. Open Reduction and Internal Fixation for the Treatment of Symptomatic Osteochondritis Dissecans of the Femoral Head in Patients With Sequelae of Legg-Calvé-Perthes Disease. J Pediatr Orthop. 2018 May 29. https://pubmed.ncbi.nlm.nih.gov/29847463/

Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001 Nov;83(8):1119-24. https://www.hip-symposium-bern.ch/files/publications/surgical-techniques/ganz-surgical-dislocation-of-the-adult-hip-technique-with-full-access-2001.pdf

Rowe SM, Moon ES, Yoon TR, Jung ST, Lee KB, Lee JJ. Fate of the osteochondral fragments in osteochondritis dissecans after Legg-Calve-Perthes‘ disease. J Bone Joint Surg Br. 2002 Sep;84(7):1025-9. https://pubmed.ncbi.nlm.nih.gov/12358366/

Rowe SM, Chung JY, Moon ES, Yoon TR, Jung ST, Lee KB. Computed tomographic findings of osteochondritis dissecans following Legg-Calvé-Perthes disease. J Pediatr Orthop. 2003 May-Jun;23(3):356-62. https://pubmed.ncbi.nlm.nih.gov/12724600/

Knorpelschäden nach Ausheilung

Jones CE, Mulpuri K, Teo T, Wilson DR, d’Entremont AG. T1ρ and T2 MRI show hip cartilage damage in adolescents with healed Legg-Calvé-Perthes disease. J Pediatr Orthop B. 2021 Jun 18

Neuere Arbeiten

Larson AN, Sucato DJ, Herring JA, Adolfsen SE, Kelly DM, Martus JE, Lovejoy JF, Browne R, Delarocha A. A prospective multicenter study of Legg-Calvé-Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Joint Surg Am. 2012 Apr 4;94(7):584-92. https://pubmed.ncbi.nlm.nih.gov/22488614/

Wenger DR. Legg-Calvé-Perthes disease: Functional prognosis in an era of high expectations: commentary on an article by A. Noelle Larson, MD, et al.: „A prospective multicenter study of Legg-Calvé-Perthes disease. Functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years“. J Bone Joint Surg Am. 2012 Apr 4;94(7):e46. https://pubmed.ncbi.nlm.nih.gov/22488630/

Kim HK, Aruwajoye O, Stetler J, Stall A. Effects of non-weight-bearing on the immature femoral head following ischemic osteonecrosis: an experimental investigation in immature pigs. J Bone Joint Surg Am. 2012;94:2228-37. https://pubmed.ncbi.nlm.nih.gov/23318613/

Kim HK, Burgess J, Thoveson A, Gudmundsson P, Dempsey M, Jo CH. Assessment of Femoral Head Revascularization in Legg-Calvé-Perthes Disease Using Serial Perfusion MRI. J Bone Joint Surg Am. 2016;98(22):1897-1904. https://pubmed.ncbi.nlm.nih.gov/27852906/

Aruwajoye OO, Monte F, Kim A, Kim HKW. A Comparison of Transphyseal Neck-Head Tunneling and Multiple Epiphyseal Drilling on Femoral Head Healing Following Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs [published online ahead of print, 2018 Jul 2]. J Pediatr Orthop. 2018;10.1097. https://pubmed.ncbi.nlm.nih.gov/29975297/?from_term=Aruwajoye+Kim+multiple+epiphyseal+drilling+tunneling&from_pos=1

Laine JC, Martin BD, Novotny SA, Kelly DM. Role of Advanced Imaging in the Diagnosis and Management of Active Legg-Calvé-Perthes Disease. J Am Acad Orthop Surg. 2018;26(15):526‐536. https://pubmed.ncbi.nlm.nih.gov/29939867/?from_single_result=Laine+Advanced+Imaging+LCPD

Laine JC, Novotny SA, Tis JE, et al. Demographics and Clinical Presentation of Early-Stage Legg-Calvé-Perthes Disease: A Prospective, Multicenter, International Study [published online ahead of print, 2020 Aug 27]. J Am Acad Orthop Surg. 2020;10.5435/JAAOS-D-19-00379. https://pubmed.ncbi.nlm.nih.gov/32868700/

Sankar WN, Laval SM, Mcguire MF, et al. Does Early Proximal Femoral Varus Osteotomy Shorten the Duration of Fragmentation in Perthes Disease? Lessons From a Prospective Multicenter Cohort. J Pediatr Orthop. 2020;40(5):e322‐e328. https://pubmed.ncbi.nlm.nih.gov/31524767/?from_single_result=Sankar+Early+Proximal+Varus+Osteotomy

Singh KA, Shah H, Joseph B, Aarvold A, Kim HKW. Evolution of Legg-Calvé-Perthes disease following proximal femoral varus osteotomy performed in the avascular necrosis stage: a prospective study. J Child Orthop. 2020;14(1):58‐67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043118/

Ren Y, Deng Z, Gokani V, Kutschke M, Mitchell TW, Aruwajoye O, Adapala NS, Kamiya N, Abu-Amer Y, Kim HKW. Anti-interleukin-6 therapy decreases hip synovitis and bone resorption and increases bone formation following ischemic osteonecrosis of the femoral head. J Bone Miner Res. 2020 Oct 14. doi: 10.1002/jbmr.4191. Epub ahead of print. https://pubmed.ncbi.nlm.nih.gov/33053220/

Kuroyanagi G, Adapala NS, Yamaguchi R, Kamiya N, Deng Z, Aruwajoye O, Kutschke M, Chen E, Jo C, Ren Y, Kim HKW. Interleukin-6 deletion stimulates revascularization and new bone formation following ischemic osteonecrosis in a murine model. Bone. 2018 Nov;116:221-231. https://pubmed.ncbi.nlm.nih.gov/30125727/

Kim HKW, Park MS, Alves do Monte F, Gokani V, Aruwajoye OO, Ren Y. Minimally Invasive Necrotic Bone Washing Improves Bone Healing After Femoral Head Ischemic Osteonecrosis: An Experimental Investigation in Immature Pigs. J Bone Joint Surg Am. 2021 Mar 11.

Selberg CM, Bram JT, Carry P, Goldstein RY, Schrader T, Laine JC, Kim HKW, Sankar WN; International Perthes Study Group. Hip Morphology in Early-stage LCPD: Is There an Argument for Anatomic-specific Containment? J Pediatr Orthop. 2021 Apr 12.

Tis JE, Laine JC, Sankar WN, Jo CH, Kim HKW; International Perthes Study Group. Reproducibility of Radiographic Measurements Made in the Active Stages of Legg-Calvé-Perthes Disease: Evaluation of a Prognostic Indicator and an Interim Outcome Measure. J Pediatr Orthop. 2021 Feb 1;41(2):93-98.

Jones CE, Mulpuri K, Teo T, Wilson DR, d’Entremont AG. T1ρ and T2 MRI show hip cartilage damage in adolescents with healed Legg-Calvé-Perthes disease. J Pediatr Orthop B. 2021 Jun 18 https://pubmed.ncbi.nlm.nih.gov/34139748/

Eigene Arbeitsgruppe

Meiss L, Delling G. Stimulation of Bone Regeneration by Fragmented Cortical Bone and Porous Calcium Phosphate Ceramics (Tricalcium Phosphate and Hydroxyapatite) – An Experimental Study and Preliminary Clinical Results. Neuere Ergebnisse in der Osteologie, H.-G. Willert, F.H.W. Heuck (Hrsg.), Springer-Verlag, Heidelberg 1989, 619-31.

Meiss L, Schäfer B, Mallien O. Morbus Perthes – aggressives Zuwarten versus schonende Operation. „Kontroverses in der Kinderorthopädie“, Münsteraner Frühjahrs-Symposium, Mai 1994, I. Hofstätter / J. Jerosch, Verlag Shaker, Aachen, 1995.

Meiss L. Prognosis in Perthes‘ disease. J Bone Joint Surg Br. 1999;81(1):179‐180. https://pubmed.ncbi.nlm.nih.gov/10068032/?from_term=Meiss+L&from_cauthor_id=10068032&from_pos=1

Meiss A L. MRT zur Diagnostik des Containment-Verlustes beim Morbus Perthes – MRI in the diagnosis of loss of containment in Perthes‘ disease. Medizinisch-Orthopädische Technik 2001;121:47-54.

Stuecker MH, Meiss AL. Monitoring of Containment in Perthes‘ Disease: Can Ultrasonography be Helpful?. Ortop Traumatol Rehabil. 2004;6(5):582‐588. https://pubmed.ncbi.nlm.nih.gov/17618206/?from_single_result=Markus+H+F+Stuecker+1%2C+A+Ludwig+Meiss

Stücker MH, Buthmann J, Meiss AL. Evaluation of hip containment in legg-calvé-perthes disease: a comparison of ultrasound and magnetic resonance imaging. Ultraschall Med. 2005;26(5):406-410. https://pubmed.ncbi.nlm.nih.gov/16240249/

Funk JF, Perka C, Pruss A, Meiss AL, Placzek R. Modifizierte Azetabuloplastik unter Verwendung von bioresorbierbaren Schrauben und lyophilisiertem allogenem Knochen [Modified acetabuloplasty using bioresorbable screws and lyophilised allogenic bone]. Z Orthop Unfall. 2008;146(6):720-724. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2008-1038797

Meiss AL, Barvencik F, Babin K, Eggers-Stroeder G. Denosumab and surgery for the treatment of Perthes‘ disease in a 9-year-old boy: favorable course documented by comprehensive imaging- a case report. Acta Orthop. 2017;88(3):354‐357. https://www.tandfonline.com/doi/full/10.1080/17453674.2017.1298020

Dissertationen (Fachbereich Medizin der Universität Hamburg)

Frauke Lange. Zur Coxa magna cartilaginea in der Frühphase des Morbus Perthes: Ergebnisse kernspintomographischer Untersuchungen und ihre Wertung, Hamburg, 1997

Christian Gauck. Die konservative Therapie des Morbus Perthes: eine Evaluierung der entlastenden Schienenversorgung, Hamburg, 1997

Lars Clarfeld. Ein neuer Ansatz in der Behandlung des Morbus Perthes: Durchtrennung des Ligamentum transversum acetabuli; Ergebnisse einer Pilotstudie. Hamburg, 2003.

Sintje Singerhoff. MR-basierte Volumetrie des Hüftkopfes und der Hüftpfanne beim Morbus Perthes und einem Normalkollektiv. Hamburg, 2007. https://ediss.sub.uni-hamburg.de/volltexte/2008/3573/pdf/Doktorarbeit_Morbus_Perthes.pdf

Weblinks zur International Perthes Study Group (IPSG)

https://perthesdisease.org/

https://perthesdisease.org/find-a-surgeon/

Modified Elizabethtown Classification-Cheatsheet https://perthesdisease.org/publicprotocols/ Miscellaneous

Perthes Update, JBJS, Dec. 2018

CLINICAL SUMMARY
Legg-Calvé-Perthes Disease
By: Paul D. Sponseller, MD
Perthes disease is the pediatric form of avascular necrosis of the femoral head. Compared to adult forms of the disorder, resorption and reossification are more pronounced. The femoral epiphysis is weakened during this process and may become flattened. Assessment of status and healing of the femoral head may be achieved with a serial perfusion MRI, requiring gadolinium administration and special software. This imaging technique demonstrated that revascularization of the femoral head in Perthes occurs in a “horseshoe” pattern, starting from posterior, medial, and lateral regions. Revascularization occurs at a variable rate, at a mean of 5% per month. This can help patients and their parents appreciate the long course of recovery from this condition.

Traditional treatments for Perthes over the past half-century have focused on decreasing harmful pressure and maintaining symmetrical loading. These have had modest success. Because most patients are treated nonoperatively, it is useful to know that at 20 years of follow-up, nearly half of Perthes patients have moderate to severe osteoarthritis, especially those having a lateral column type B, B/C, or C, or those who heal with Stulberg grade 4 or 5 asphericity. Femoroacetabular impingement is also common.

Femoral osteotomy can improve femoral head sphericity, but amounts of varus over 10° have not shown benefit. A meta-analysis of femoral and Iliac osteotomies has shown improved sphericity compared with nonoperative treatment in children older than 6 years of age. Osteotomies are most effective when performed before the advanced fragmentation phase. Combined femoral and iliac osteotomies do not provide improved results over historically published results of either osteotomy alone. Investigations into newer biological treatments aimed at decreasing resorption and increasing reossification are underway. These have promise to improve future outcomes.

The results of eventual hip replacements in Perthes patients should be closely monitored, especially in the setting of osteotomies during childhood. A retrospective study reported a 96% hip-replacement survival rate at 15 years in young adults, though there was a 6% rate of permanent sciatic palsy.

https://jbjs.org/summary.php?id=183

Related Content from JBJS:
The Pathogenesis And Treatment Of Legg-Calvé-Perthes Disease
Images Related to Legg-Calvé-Perthes Disease

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