A review of the morphology of Perthes' disease

Abstract

There are differences of opinion about the pathogenesis of Perthes' disease. All are agreed that it is due to ischaemia, but the cause of this and the size and number of infarctions are in dispute. Through the generosity of the contributors six whole femoral heads and core biopsies of five other cases have been studied radiographically and histologically. The findings ranged from an ischaemic arrest of ossification in the capital articular cartilage without infarction to multiple complete infarctions of the epiphysial bone. The ensuing reparative process contributes to the pathology, which is of a range to warrant grading or grouping.

Does Surgical Hip Dislocation and Periacetabular Osteotomy Improve Pain in Patients With Perthes-like Deformities and Acetabular Dysplasia?

“…The use of surgical hip dislocation as the primary means of treatment for symptomatic residual Perthes deformities has become more common [1,3,7,14,15,25,28,30]. Surgical dislocation simultaneously allows for assessment and treatment of intraarticular labrochondral pathology as well as biomechanical alteration of the hip with trochanteric advancement and relative femoral neck lengthening [1,3,28,30].…”

Femoral Head Deformation and Repair Following Induction of Ischemic Necrosis

“…The piglet model leads to femoral head deformity similar to Legg-Calvé-Perthes disease 1,2,4,5,[22][23][24] , with histologic changes characteristic of human cases [25][26][27][28][29][30][31][32][33] . Studies from humans with the disease have recognized the changes to be intermingling of necrosis and repair 25,27 , new bone formation by intramembranous ossification 30 , increased thickness of the surface cartilage 31 , retained shape and internal structure of the most medial portion of the head, and (in the central and lateral aspects of the head) a callus-like fibrocartilage, vascular granulation tissue, new bone formation on necrotic trabeculae, and chondroid tissue 32,33 .…”

“…Studies from humans with the disease have recognized the changes to be intermingling of necrosis and repair 25,27 , new bone formation by intramembranous ossification 30 , increased thickness of the surface cartilage 31 , retained shape and internal structure of the most medial portion of the head, and (in the central and lateral aspects of the head) a callus-like fibrocartilage, vascular granulation tissue, new bone formation on necrotic trabeculae, and chondroid tissue 32,33 . Magnetic resonance imaging has been used over the past two decades to assess Legg-Calvé-Perthes disease, but the studies lack histologic correlation [34][35][36][37] .…”

Indentation properties of growing femoral head following ischemic necrosis

“…It can also arise from a common idiopathic condition called Legg-Calve-Perthes disease [3]. In many instances, ischemic necrosis produces permanent fenioral head deformity that can lead to premature degenerative arthritis [I ,13,18].…”