Orthopedics

Early Diagnosis Is Key to Better Outcomes in Perthes

Johns Hopkins Orthopaedic Surgery
December 10, 2014

Catching Perthes early is tricky, says John Tis, and a missed diagnosis can be a major challenge to successful treatment.

Even though it was first described more than a century ago, Legg-Calve-Perthes disease is so rare—it affects just five to 10 per 100,000 children under the age of 15—that little is known about which treatments are best. Most common in children ages 4 to 9 years, it is four times more common in boys than girls, says John Tis, a pediatric orthopaedic surgeon at Johns Hopkins.


Perthes occurs when blood flow to the femoral head of the hip joint is interrupted, eventually causing the bone to die. As a result, the hip can break—and heal poorly. But which treatment is best? Should a Perthes diagnosis always mean surgery?

In an effort to close the knowledge gap, Tis has become part of the International Perthes Study Group—a collection of 45 surgeons and researchers who are enrolling children with Perthes in a central database to enable long-term studies on the diagnostics, treatment and outcomes of the disease.

“We have interventions, but we don’t really know how they are working until we get 10 years of follow-up,” says Tis, who has been treating Perthes patients for more than a decade.  

If diagnosed with Perthes in the first few months, the majority of patients can be treated with anti-inflammatory drugs and physical therapy, Tis has found. But many children older than 8 and a minority of younger children with Perthes will have a large loss of blood flow and require surgery. “If we can act before the body starts absorbing the bone—in the first six to 12 months—and put the hip in a contained position,” says Tis, “then the femoral head will mold into a more normal, round shape that matches the acetabulum.”