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What is Perthes Disease?
Legg-Calvé-Perthes disease is a condition in which blood supply to the femoral head is disrupted, leading to avascular (non-infectious) necrosis. It most commonly affects children 3-12 years old (peak incidence 5-7 years), predominantly boys (4:1 ratio).
The disease progresses cyclically: necrosis → fragmentation → healing → remodeling. The natural course takes 2-5 years. The primary concern is deformity of the femoral head, which can lead to early osteoarthritis in adulthood.
Stages of disease (Waldenström classification):
- I — Necrosis — disruption of blood supply, beginning of destruction. X-rays may appear normal
- II — Fragmentation — femoral head breaks down, areas of lysis appear. The most critical period
- III — Healing — new bone tissue growth, reossification
- IV — Remodeling — final shaping of the head. Deformity (coxa plana, coxa magna) determines long-term prognosis
Facts about Perthes Disease
- ICD-10: M91.1
- Age: 3-12 years (peak 5-7)
- Gender: boys 4 times more often
- Bilateral: 10-15% of cases
- Duration: 2-5 years
- Risk: early hip osteoarthritis with deformity
Symptoms of Perthes Disease
Early signs
- Limping (child limps without apparent cause)
- Pain in the groin, thigh, or knee
- Limited hip rotation and abduction
- Fatigue with walking
- Muscle spasm
Progression
- Limb shortening
- Atrophy of thigh and buttock muscles
- Marked limitation of movement
- Inability to run and jump
- Positive Trendelenburg sign
Prognostic factors
- Age of onset — before age 6 has better prognosis
- Degree of involvement — Herring classification (A, B, C)
- Preservation of shape — the less deformation, the better
- Early treatment — the key to a good outcome
Legg–Calvé–Perthes disease: treatment options and what is known about them
The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.
| Option | What to expect | How well studied |
|---|---|---|
| Load management, weight loss | Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain | Moderate evidence |
| Braces, splints, insoles | Offload and stabilise, reduce pain under load | Limited or conflicting evidence |
| Exercise therapy and physiotherapy | Reduces pain, strengthens muscles, improves function; the basis of treatment | Moderate evidence |
| PRP / CGF | — | Not usually used for this diagnosis |
| Osteotomy (decided by a paediatric orthopaedist) | If conservative treatment does not help or there is an indication | When indicated — the doctor decides |
We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.
Regenerative methods: realistic expectations
Perthes disease affects children. Treatment is led by a paediatric orthopaedist: monitoring, activity restriction, exercise therapy, sometimes braces or surgery so that the femoral head develops properly. Regenerative injections are not used in children with this disease.
When surgery is discussed. Surgery (osteotomy) is considered by the paediatric orthopaedist depending on the child’s age and how much of the femoral head is affected.
Good to know: diagnosis, self-help, outlook
How to recognise Perthes disease
Legg–Calvé–Perthes disease is a loss of blood supply to the femoral head in children, most often boys aged 4–8. Early signs are limping and pain in the groin, thigh or knee after activity; knee pain is often misleading. Transient synovitis also causes limping but settles within 1–2 weeks. The diagnosis is confirmed by X-ray and MRI, which detects early stages.
What parents can do
Limit jumping and running while keeping swimming and cycling, watch the range of hip motion and do the exercises prescribed by the physician. Regular orthopaedic check-ups and follow-up X-rays are essential, as further treatment depends on the shape of the femoral head.
Outlook and timelines
The disease lasts 2–5 years as the femoral head passes through stages of breakdown and healing. The younger the child at onset, the better the outcome usually is. In older children and with extensive involvement of the head, an osteotomy is discussed to preserve its shape.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- Severe stage IV osteoarthritis with axial deformity and joint destruction — joint replacement is usually discussed instead.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Ye Y et al. Platelet rich plasma versus hyaluronic acid in patients with hip osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg, 2018.
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently Asked Questions about Perthes Disease Treatment
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.
The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.
Clinic and method matching — free of charge
Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.
Send a request