The pathogenesis of Perthes' disease

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Pathology

Background:

• Perthes' disease causes femoral head deformity in children.
• Previous studies suggest infarction plays a role in Perthes' disease development.
• Puppy models demonstrate that repeated infarction leads to femoral head changes.

Purpose of the Study:

• To investigate the histological evidence of double infarction in human Perthes' disease specimens.
• To determine the prevalence of histopathological changes indicative of repeated infarction in Perthes' disease.
• To evaluate the contribution of infarction to femoral head deformation and disease chronicity.

Main Methods:

• Histological examination of 57 femoral head biopsy specimens from patients with Perthes' disease.
• Analysis of characteristic histopathological changes associated with double infarction.
• Comparison of findings with radiological and clinical presentations of Perthes' disease.

Main Results:

• Histopathological changes consistent with double infarction were identified in 51% of the studied femoral head specimens.
• Evidence suggests that double infarction may occur in a higher percentage of cases.
• The findings indicate a significant role for repeated infarction in the pathogenesis of Perthes' disease.

Conclusions:

• Repeated episodes of infarction and subsequent growth abnormalities are likely major contributors to femoral head deformation in Perthes' disease.
• These findings challenge the sole emphasis on mechanical weight-bearing factors in disease etiology.
• The study supports the concept that infarction is a key factor in the chronicity and presentation of Perthes' disease.