Perthes Disease Treatment
In Singapore

It can be worrying for parents to see a child limping or complaining of hip pain. Perthes disease is a childhood condition that affects the blood supply to the ball of the hip joint and may benefit from assessment by a paediatric orthopaedic specialist. Our Senior Consultant orthopaedic surgeon provides evaluation and treatment based on each child’s condition and stage of disease.

Dr Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)MMed (SG)MRCS (Glasgow)FRCSEd (Orth)

Causes & Risks Symptoms When to see a Doctor Diagnosis Treatment Complications Prevention FAQ Conclusion

What is Perthes Disease?

Perthes disease, also known as Legg-Calvé-Perthes disease, is a childhood condition where temporary loss of blood supply to the femoral head causes the bone to gradually break down (avascular necrosis). As blood flow returns, the bone regenerates, but this process can take several years. During this time, the softened bone is usually vulnerable to flattening and deformation.

Causes

The exact cause of blood flow disruption in Perthes disease remains unknown. Current research suggests multiple factors may contribute:

Repeated minor trauma to the hip joint
Temporary blockage of blood vessels supplying the femoral head
Blood clotting abnormalities
Increased pressure within the joint

Risk Factors

Several factors increase a child’s likelihood of developing Perthes disease:

Age: Most common between 4-8 years old
Gender: Boys have 4-5 times higher risk
Family history: Slightly increased risk if siblings or parents had the condition
Low birth weight: Children born prematurely or with low birth weight
Exposure to secondhand smoke: Environmental tobacco smoke increases risk
Asian ethnicity: Lower incidence compared to Caucasian populations
Hyperactivity disorders: Some studies suggest correlation with ADHD
Delayed bone age: Children with slower skeletal maturation

Signs & Symptoms

Early Symptoms

Mild limp, especially after physical activity
Occasional hip or groin discomfort
Stiffness after sitting for extended periods
Reduced range of motion during play
Child may not complain of pain initially

Progressive Symptoms

More pronounced limp throughout the day
Pain extending to thigh or knee area
Difficulty with activities like running or jumping
Leg appears shorter on affected side
Muscle wasting in thigh and buttock

Advanced Symptoms

Persistent pain even at rest
Significant limping requiring walking aids
Unable to bear weight on affected leg
Marked leg length discrepancy
Hip joint stiffness and deformity

The symptoms of Perthes disease typically develop gradually over weeks to months. Parents often notice the limp before the child complains of pain, as young children may adapt their activities to avoid discomfort.

Experiencing these symptoms?

Schedule a consultation with our Senior Consultant Orthopaedic Surgeon to discuss a personalised treatment plan.

Book Appointment

When to See a Doctor

Prompt medical evaluation is essential if your child displays any concerning hip symptoms. Seek immediate consultation if you notice:

Persistent limping for more than one week
Hip, thigh, or knee pain lasting several days
Reluctance to participate in usual physical activities
Morning stiffness or difficulty getting out of bed
Any fall or injury followed by ongoing hip problems

During the initial consultation, our orthopaedic surgeon will perform a thorough physical examination, assess your child’s gait, and review their medical history. Early diagnosis allows for better monitoring and timely intervention when necessary. The appointment typically includes gentle range-of-motion tests and may require imaging studies. Parents should prepare to discuss symptom onset, duration, and any activities that worsen or improve the condition.

Diagnosis & Testing Methods

Accurate diagnosis of Perthes disease typically requires comprehensive evaluation combining clinical examination with modern imaging:

X-rays (Radiographs): Standard X-rays remain the primary diagnostic tool, showing characteristic changes in the femoral head. Initial X-rays may appear normal, as bone changes take time to become visible. Serial X-rays help monitor disease progression and healing.
MRI (Magnetic Resonance Imaging): MRI provides detailed images of both bone and soft tissue, detecting early changes before they appear on X-rays. This non-invasive scan helps determine the extent of femoral head involvement and guides treatment decisions.
Bone Scan: Occasionally used to assess blood flow to the femoral head, particularly in early stages when diagnosis is uncertain. This involves injection of a small amount of radioactive material that concentrates in areas of active bone metabolism.
Arthrography: In selected cases, contrast dye injection into the hip joint provides detailed information about cartilage shape and joint congruency, helping surgical planning.

Our orthopaedic surgeon will determine which tests are necessary based on your child’s age, symptoms, and initial examination findings. Results typically available within days allow prompt treatment planning.

Treatment Options Overview

Conservative Management

For younger children (under 6 years) with minimal femoral head involvement, observation with activity modification often suffices. This approach typically includes regular monitoring through clinical examinations and X-rays around every 3-4 months to track healing progress.

Activity Modification

Structured activity programmes help to balance rest with appropriate exercise. Swimming and cycling can maintain fitness without stressing the hip joint. High-impact activities like running and jumping usually require temporary restriction during the active disease phase.

Physiotherapy

Specialised paediatric physiotherapy maintains hip flexibility and strengthens surrounding muscles. The sessions may teach gentle stretching exercises and provide gait training. Hydrotherapy sessions can offer low-impact exercise options particularly beneficial during painful phases.

Bracing and Casting

Abduction braces or casts position the femoral head within the socket, promoting spherical healing. Modern lightweight braces may allow some mobility while maintaining proper hip alignment. Duration typically ranges from several months to over a year depending on healing response.

Anti-inflammatory Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and reduce joint inflammation. Appropriate paediatric dosing helps to ensure safety while providing symptom relief. Our surgeon carefully monitors medication use and may adjust accordingly.

Soft Tissue Release

Adductor tenotomy can relieve muscle tightness and improves hip motion. This minor procedure, often performed alongside other treatments, may enhance joint flexibility and reduce pressure on the femoral head.

Femoral Osteotomy

Surgical realignment of the thighbone may improve femoral head positioning within the socket. This procedure, commonly recommended for older children with significant deformity, usually involves cutting and repositioning bone secured with plates and screws.

Pelvic Osteotomy

Reshaping the hip socket may provide better coverage of the femoral head. Various techniques may be applied depending on the child’s age and specific anatomy. Recovery typically involves several months of protected weight-bearing.

Combined Procedures

Some children may benefit from simultaneous femoral and pelvic procedures, addressing both sides of the hip joint. Our orthopaedic surgeon can help to determine the surgical approach based on comprehensive imaging and individual factors.

Every patient’s condition is unique.

Our Senior Consultant Orthopaedic Surgeon will assess your specific situation and recommend the most suitable treatment approach for you.

Schedule Consultation

Complications if Left Untreated

Without appropriate management, Perthes disease can lead to significant long-term problems affecting your child’s mobility and quality of life. The damaged femoral head may heal with permanent deformity, creating an irregularly shaped ball that doesn’t fit properly in the hip socket. This incongruency causes premature cartilage wear, leading to early-onset arthritis potentially requiring hip replacement in young adulthood.

Untreated Perthes disease often results in chronic hip pain, persistent limp, and reduced activity levels. Children may develop compensatory movement patterns straining other joints, particularly the opposite hip and lower back. Leg length differences become permanent, requiring shoe modifications or causing ongoing discomfort. The psychological impact includes reduced participation in sports and physical activities, affecting social development and self-esteem. Early evaluation and appropriate management may help support better outcomes, preserve hip function, and reduce the risk of these complications.

Prevention

While Perthes disease cannot be entirely prevented due to its unclear causation, certain measures may reduce risk or severity. Maintaining a smoke-free environment is crucial, as exposure to secondhand smoke increases disease risk. Parents should ensure children maintain healthy body weight, reducing mechanical stress on developing hip joints.

Regular physical activity promotes good circulation and bone health, though excessive high-impact sports in young children should be balanced with rest periods. Proper nutrition supporting bone development includes adequate calcium, vitamin D, and protein intake. Early recognition of symptoms allows prompt treatment, potentially preventing progression to more severe stages. For families with history of Perthes disease, increased vigilance for early signs enables timely medical evaluation. While these measures cannot guarantee prevention, they support overall musculoskeletal health and may influence disease outcomes if Perthes develops.

Perthes Disease

Frequently Asked Questions

Can Perthes disease affect both hips?

When both hips are affected, they usually develop the condition at different times rather than simultaneously. A doctor may monitor the unaffected hip during follow-up visits to detect any early changes. Bilateral cases may require modified treatment approaches and longer overall management periods.

How long does Perthes disease take to heal?

The healing process in Perthes disease typically takes 2-4 years from onset to completion. The timeline varies based on the child’s age at diagnosis, with younger children generally healing faster. The disease progresses through distinct stages: initial (blood supply loss), fragmentation (bone breakdown), reossification (new bone formation), and remodelling (final shaping). Regular monitoring throughout this period ensures appropriate treatment adjustments.

Will my child need surgery for Perthes disease?

Not all children with Perthes disease require surgery. Treatment decisions depend on multiple factors including age at onset, extent of femoral head involvement, and hip joint mobility. Younger children (under 6 years) with good range of motion often respond well to conservative management. Older children or those with considerable involvement may be considered for surgical intervention to help maintain femoral head shape and reduce the risk of deformity.

Can my child participate in sports with Perthes disease?

Activity levels require careful management throughout the disease course. During active phases, high-impact activities need restriction to protect the softened femoral head. Swimming and cycling provide good exercise alternatives. As healing progresses, gradual return to activities occurs under medical guidance. Many children may return to sports after healing, though some may need ongoing activity modifications.

What are the long-term outcomes for children with Perthes disease?

Long-term outcomes largely depend on the child’s age at onset and femoral head shape at healing completion. Children diagnosed before age 6 generally have good outcomes with minimal long-term effects. Older children or those with significant femoral head deformity may experience some activity limitations or early arthritis. Appropriate management may help improve outcomes, with many children potentially maintaining active lifestyles into adulthood.

How often will my child need follow-up appointments?

Follow-up frequency varies with disease stage and treatment approach. During active treatment, appointments typically occur every 3-4 months for clinical assessment and X-rays. Post-treatment monitoring continues annually until skeletal maturity, ensuring no late complications develop. A doctor may tailor the follow-up schedule to each child’s specific needs and treatment response.

Are there any genetic factors in Perthes disease?

While Perthes disease isn’t directly inherited, genetic factors may influence susceptibility. Siblings of affected children have slightly increased risk, approximately 1 in 35 compared to general population risk of 1 in 10,000. Some families show multiple affected members across generations, suggesting possible genetic predisposition. Most cases occur sporadically without family history. Genetic counselling isn’t routinely recommended unless multiple family members are affected.

What should I expect during my child’s recovery from surgery?

Surgical recovery varies depending on the procedure performed. Initial hospitalisation typically lasts 2-5 days with pain management and mobility training. Children may require crutches or wheelchairs for 6-12 weeks post-surgery. Physical therapy begins early to maintain flexibility and prevent muscle weakness. Return to full activities occurs gradually over 3-6 months. Healthcare teams may provide guidance on recovery timelines and support throughout the rehabilitation process.

Conclusion

Perthes disease presents unique challenges for children and their families. With appropriate medical assessment and management, care is focused on supporting hip development and joint health. Early recognition of symptoms and timely evaluation by a doctor familiar with paediatric orthopaedic conditions help guide effective treatment planning. Through regular monitoring and appropriate interventions, the goal is to maintain hip function and support children in staying active as they grow.

Take the First Step Towards Better Health

Living with Perthes disease can be challenging, but support and guidance are available. Our Senior Consultant Orthopaedic Surgeon can assess your child and recommend appropriate, evidence-based management options.

Book Your Consultation Today

Dr Zackary Chua (蔡克祥医生)

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (AUS)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A senior consultant orthopaedic surgeon with dual specialisations in Foot & Ankle Surgery and Paediatric Orthopaedics. Backed by his extensive years of training and experience, Dr Chua brings the necessary knowledge and skills to ensure a smooth recovery journey.

Rooted firmly by two fundamental philosophies: “When one’s feet hurt, one hurts all over” and “Children are not little adults”, Dr Chua’s approach to patient care reflects his compassionate care for adults and children.

Singhealth Quality Excellence Award – Silver (2011)
Service From the Heart Award (2021)
Singapore Health Quality Service Award – Gold (2023)
NUS Medicine Dean’s Award for Teaching Excellence (2023)

His active participation in the medical community extends to mentoring, research supervision, and contributions to key professional forums and symposiums, both locally and internationally.