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A review of the morphology of Perthes' disease
Insights
Perthes' disease pathogenesis is debated, though ischemia is agreed upon. This study examined femoral heads, revealing varied infarction sizes and types, suggesting a need for disease grading.
Area of Science:
- Orthopedics
- Pediatric Bone Diseases
- Pathology
Background:
- Perthes' disease pathogenesis is debated, with consensus on ischemia but disagreement on its cause and extent.
- Understanding the infarction's scale and frequency is crucial for comprehending the disease's development.
Purpose of the Study:
- To investigate the radiographic and histological findings in Perthes' disease.
- To characterize the range of ischemic events and subsequent pathology in femoral heads.
- To explore the potential for grading or grouping Perthes' disease based on observed pathology.
Main Methods:
- Radiographic and histological examination of six whole femoral heads.
- Core biopsies from five additional Perthes' disease cases were analyzed.
Main Results:
- Findings demonstrated a spectrum of ischemic events, from avascular necrosis of the capital articular cartilage without infarction to extensive epiphyseal bone infarction.
- The reparative process was observed to significantly contribute to the overall pathology.
- Pathological variations suggest a range of disease severity.
Conclusions:
- The study confirms ischemia as the underlying cause of Perthes' disease.
- A wide range of infarction patterns and severity exists, impacting the femoral head.
- The observed pathological spectrum supports the need for a grading or grouping system for 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.