Avascular necrosis (AVN) of the femoral head, also known as osteonecrosis, is a condition where blood supply to the hip joint is disrupted. Without adequate circulation, bone tissue in the femoral head begins to die, potentially leading to joint collapse and severe mobility issues.
AVN often develops gradually, and early detection is crucial to preventing long-term joint damage. Although it can affect individuals of any age, it is most commonly seen in people between 20 and 50 years old. Maintaining a healthy lifestyle and addressing underlying medical conditions can help lower the risk of developing AVN.
What is Perthes Disease?
The exact cause of Perthes Disease remains unknown. Researchers believe it may be linked to genetic, environmental, or vascular factors. The loss of blood supply to the femoral head happens without any clear reason, making it difficult to predict or prevent. However, some theories suggest that underlying blood clotting disorders or delayed bone development could play a role.
What Causes Perthes Disease?
Early detection of Perthes Disease is crucial for effective management. Symptoms often develop gradually and may include:
A noticeable limp, sometimes without pain
Hip stiffness and restricted range of motion
Pain in the hip, groin, thigh, or knee
Muscle weakness and atrophy around the affected hip
Shortening of the affected leg in advanced stages
If your child is limping persistently or complaining of hip discomfort, it’s important to seek medical assessment.
Symptoms of Perthes Disease
How is Perthes Disease Diagnosed?
Diagnosing Perthes Disease involves a combination of clinical evaluation and imaging tests. A physiotherapist or doctor will assess hip movement and identify any stiffness or mobility issues.
X-rays: Usually the first imaging tool used to determine the position of the femoral head.
MRI scans: Used for detailed imaging and early detection and best to confirm the diagnosis.
Bone scans: Sometimes employed to evaluate blood flow and bone health.
Treatment Options for Perthes Disease
Treatment for Perthes Disease depends on the child's age, the severity of the condition, and the stage of bone deterioration. The goal is to maintain hip function and support proper bone healing while minimising long-term joint damage.
Non-Surgical Treatment (Conservative Management)
For children under six or those with mild cases, non-surgical approaches are often recommended. These may include:
Activity modification: Avoiding high-impact activities like running and jumping to reduce joint stress.
Physiotherapy: Strengthening and stretching exercises to maintain hip mobility and muscle support. Rehabilitation after surgery (if it was indicated).
Crutches or mobility aids: Used if walking becomes too painful.
Bracing or casting: In some cases, these methods help maintain hip alignment and prevent further flattening of the femoral head.
Surgical Intervention
For more severe cases, surgery may be required to improve joint alignment and prevent long-term complications. Surgical options include:
Muscle release procedures: To alleviate tightness and improve hip mobility.
Osteotomy (bone realignment surgery): Adjusting the femur or pelvis to improve joint positioning.
Post-surgical rehabilitation involves structured physiotherapy to restore strength, flexibility, and function.
Long-Term Outlook and Prognosis
While many children recover well from Perthes Disease with proper treatment, some may experience long-term effects such as early-onset hip arthritis. In rare cases, a total hip replacement may be necessary later in life.
How Melbourne Physio Clinic Can Help
Our team at Melbourne Physio Clinic provides expert care for children with Perthes Disease. From early diagnosis to rehabilitation, we offer tailored physiotherapy programs to enhance mobility, reduce pain, and support recovery. If you suspect your child may have Perthes Disease, contact us today for a professional assessment and guidance on the best treatment path.