LEG CALVE PERTHES DISEASE #pediatricorthopedics #pediatricorthopedics #perthesdisease

Dikkal and Pertes disease is a condition that affects the hip, particularly in children aged 4-6 years, in which the blood supply to the hip, specifically the femoral head, is disrupted. The cause is unknown. Around 1905-1910, three different European experts on Dikkal and Pertes disease, along with an orthopedic specialist, simultaneously described this condition. Despite over 100 years having passed, we have not made significant progress in understanding its etiology. It can affect one hip or both hips.

If it affects both hips, it is necessary to review all potential risks to the body, such as thyroid hormones. Is there a hormonal disorder? If it occurs in one hip, we cannot provide much information about the etiology. However, since we have followed thousands of children, the literature on this subject is very strong. What stages will this child go through? We know them. We also know the risk factors and how the child will respond to this disease.

How do we know? Did it start at an early age? Is it a girl or a boy? How much of the head is affected? What is the potential for recovery? Pertes disease is actually a condition where the epiphysis of the femoral head, i.e., the head of the femur in the hip, undergoes fragmentation—breaking down and shrinking—due to prolonged lack of blood supply, leading the body to reform the head. It requires time to heal.

What do we do in orthopedics here? As pediatric orthopedists, our clear approach is to keep the head in a maximally spherical position during the healing period, meaning it should be able to move comfortably within the joint like a round ball, as if it were a healthy hip. This is the theory, this is the approach, this is the algorithm. Whatever you do, the femoral head must continue to move and function within the socket in a coordinated manner, without any restriction of movement, so that during the healing period, i.e., the period of re-vascularization, it can form a joint that is close to normal or normal. This requires time.

Therefore, the earlier we start, the better the prognosis. The later we start, the more critical it becomes for the child to recover. If we start late, we are a bit more careful. We perform physical examinations, try to maintain equal range of motion in both joints, send the child for physical therapy, and if necessary, perform minor muscle surgeries to equalize joint movements. If we see that it is protruding from the socket, we add some bone surgeries to keep it aligned with the socket. Whatever we do, we raise this child with a femoral head that is aligned with the socket.

It has been scientifically proven that the closer we can bring the alignment of the socket and the head to a healthy state, the more rounded, smooth, non-calcified, cartilage-damaged, and free from joint pain for a long time the child will be able to live with that joint once their growth is complete. Perthes disease is such a condition. It does not heal immediately and requires close monitoring. It persists during the growth period. The age at which it begins, which hip is affected, and whether it is unilateral or bilateral are important factors. Therefore, it is a pathology where we can achieve good outcomes in cases closely monitored by physical therapy, rehabilitation, and pediatric orthopedics.