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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Clinically, Perthe's disease occurs in boys four times as frequently as girls

  • the child is usually between 5 and 12 years old
  • in general the child is quite well, but may be short
  • usually there is no history of trauma.

The symptoms usually have been present for weeks as the child often does not complain and may include:

  • an intermittent limp (abductor lurch), especially after exertion – classically painless (1)
  • mild or intermittent pain in the groin area (often present only during physical activity)
    • may refer to knee and thigh in 25% of the patients
    • in some cases knee pain without groin or thigh pain will lead to delay in diagnosis (1)

On examination the hip may appear normal.

  • there may be some muscle wasting, the affected leg’s thigh circumference is smaller than the other side.
  • may develop hip adduction flexion contracture
  • painful gait - Trendelenburg's sign may be positive
  • short stature
  • leg length inequality due to collapsed epiphysis or an adduction contracture (1).
  • mobility of the joint is dependent on when the condition presents
    • in the early disease the hip joint is irritable and all movements are limited and their extremes are painful
    • if the condition is seen later then most movements are full. However, even in this later presentation abduction and internal rotation are usually limited. A fixed flexion deformity may be revealed by Thomas' test (1), where the uninvolved flexed leg is held against the abdomen of the supine patient to flatten the lumbar lordosis. If a hip flexion contracture is present in the opposite leg then it will not remain on the couch

Occasionally this condition may be bilateral (in 10% to 15% of children), usually in temporally staggered fashion, rather than simultaneously (1).


  1. Nelitz M, Lippacher S, Krauspe R, Reichel H. Perthes Disease Current Principles of Diagnosis and Treatment Dtsch Arztebl Int. 2009 July; 106(31-32): 517–523.

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