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"Perthes-like" changes in a free riding untreated congenital dislocated hip
Ismat B Ghanem1, Vernon T Tolo
1Department of Orthopaedics, Hôtel-Dieu de France University Hospital-Saint Joseph University, Beirut, Lebanon. ghanem.i@dm.net.lb
Insights
This case study reports Perthes-like disease in an untreated congenital dislocation of the hip (CDH). It suggests hip joint contact may not be essential for developing femoral head ischemic changes.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Radiology
Background:
- Congenital dislocation of the hip (CDH) can lead to avascular necrosis of the femoral head (AVN) post-treatment.
- Perthes-like changes are typically associated with contact between the femoral head and acetabulum.
Observation:
- An 8-year-old girl with untreated CDH presented with leg length discrepancy and left hip stiffness.
- Radiographs revealed a high-riding left hip dislocation with a small, dense femoral head.
- MRI showed decreased signal in the entire left femoral head.
Findings:
- The patient was diagnosed with Perthes-like disease in the setting of untreated CDH.
- Hematologic and metabolic evaluations were normal.
- This case challenges the necessity of joint contact for developing ischemic changes in the femoral epiphysis.
Implications:
- The findings suggest a potential alternative pathogenesis for Perthes-like disease.
- This challenges the established vascular theory of Perthes disease.
- Further research is needed to understand the role of joint contact in femoral head ischemia.
Abstract:
The development of avascular necrosis of the femoral head (AVN) after the treatment of congenital dislocation of the hip (CDH) is a well-known complication, but the coexistence in an old child of untreated CDH and ischemic changes of the femoral head has not been reported. Many authors and several years of clinical observation have shown that Perthes-like changes do not occur unless the two sides of the joint are in contact. The purpose of this paper was to report a case of Perthes-like disease that occurred in an untreated CDH, and to discuss the possible pathogenesis. The patient is an 8-year-old African American girl, who presented with a leg length discrepancy, and very mild complaints at the left hip. Physical examination revealed left hip stiffness with a positive Galeazzi sign. Pelvic radiographs showed a complete high riding dislocation of the left hip, with a small and dense femoral head. MRI showed a decreased signal of the entire femoral head. Hematologic and metabolic work-up was normal. Although the vascular theory seems to be well accepted in the pathogenesis of Perthes disease, it does not seem that the contact between the femoral head and the acetabulum is necessary to produce ischemic changes of the femoral epiphysis.
