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Perthes' osteochondropathy.
Last reviewed: 05.07.2025
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A disease in which the blood supply to the femoral head is disrupted with its subsequent aseptic necrosis is Perthes osteochondropathy. It is a fairly common pathology and accounts for about 17% of the total number of aseptic necrosis. It occurs in childhood or adolescence. In this case, both unilateral and bilateral damage is possible, but the second joint suffers less and recovers faster.
Causes osteochondropathies
Degenerative-dystrophic process in bones refers to polyetiological diseases. There is a theory that this disorder is closely related to congenital underdevelopment and anomalies of the lumbar spinal cord. Risk factors for Perthes disease include:
- Mechanical injuries: bruises, sprains.
- Inflammation of the hip joint in infectious diseases.
- Hormonal disorders.
- Genetic predisposition and susceptibility to myelodysplasia.
- Disruption of mineral metabolism, especially calcium and phosphorus.
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Symptoms osteochondropathies
Symptoms include dull pain when walking, localized in the hip joint. Discomfort in the knee and throughout the leg is also possible. The patient begins to limp, dragging the affected limb. With further progression, swelling of the soft tissues in the joint area, limited movement, and difficulty walking occur. Vegetative disorders in the distal parts of the affected leg are also possible: a cold and pale foot with increased sweating, subfebrile body temperature. Subsequently, shortening of the limb and development of arthrosis are observed.
Stages
There are five main stages of the pathological process:
- Disruption (cessation) of blood supply, formation of a focus of aseptic necrosis.
- Impression fracture of the femoral head in the area of primary destruction.
- Slow resorption of necrotic tissue and shortening of the femoral neck.
- Proliferation of connective tissue at the site of necrosis.
- Fracture healing is the replacement of connective tissue with new bone.
Diagnostics osteochondropathies
Treatment osteochondropathies
Treatment includes complete unloading of the limb, application of skeletal traction and plaster casts. Medications are prescribed to improve blood supply to the joint, stimulate the processes of resorption of damaged tissues and bone restoration. In case of severe deformation and subluxation of the hip, rotational transposition of the acetabulum according to Salter or corrective medializing osteotomy of the hip is indicated.
Forecast
The prognosis of this form of pathology depends entirely on the size and localization of necrosis. If the lesion is small, there is a chance for full recovery. With extensive destruction, the femoral head disintegrates into several fragments, which, when fused, acquire an irregular shape. This entails further pathological changes, the formation of contractures, and coxarthrosis.