Perthes' 1910 paper describes seven affected hips in six patients with a juvenile hip condition he termed 'arthritis deformans juvenilis.' The central question is whether this represents a distinct entity separable from tuberculosis of the hip and coxa vara. This is the foundational clinical and radiographic description of what is now universally called Legg-Calvé-Perthes disease.
When a child presents with a limp and clinical examination shows preserved flexion but restricted abduction and rotation, Perthes disease is the diagnosis until proven otherwise — not hip tuberculosis, not coxa vara.
The motion pattern itself is the diagnostic key: tuberculosis restricts motion globally through muscle spasm with pain on pressure; Perthes restricts motion selectively through mechanical incongruity without significant pain on examination. Get an X-ray. Clinical exam cannot distinguish Perthes from coxa vara.
This paper is the reason we avoid immobilization in Perthes disease and instead emphasize motion preservation and abductor strengthening. Perthes explicitly stated that weight bearing worsens deformity and that passive motion could mold the joint toward a more functional shape. A philosophy that directly prefigured the containment treatment paradigm formalized in subsequent decades.
The formal classification systems used today (Catterall 1971, Herring lateral pillar 1992) are built on the radiographic progression Perthes described here. Flattening of the superior epiphysis advancing to near-complete epiphyseal loss with secondary acetabular remodeling.
Perthes' 1910 paper describes seven affected hips in six patients with a juvenile hip condition he termed 'arthritis deformans juvenilis.' The central question is whether this represents a distinct entity separable from tuberculosis of the hip and coxa vara. This is the foundational clinical and radiographic description of what is now universally called Legg-Calvé-Perthes disease.
When a child presents with a limp and clinical examination shows preserved flexion but restricted abduction and rotation, Perthes disease is the diagnosis until proven otherwise — not hip tuberculosis, not coxa vara.
The motion pattern itself is the diagnostic key: tuberculosis restricts motion globally through muscle spasm with pain on pressure; Perthes restricts motion selectively through mechanical incongruity without significant pain on examination. Get an X-ray. Clinical exam cannot distinguish Perthes from coxa vara.
This paper is the reason we avoid immobilization in Perthes disease and instead emphasize motion preservation and abductor strengthening. Perthes explicitly stated that weight bearing worsens deformity and that passive motion could mold the joint toward a more functional shape. A philosophy that directly prefigured the containment treatment paradigm formalized in subsequent decades.
The formal classification systems used today (Catterall 1971, Herring lateral pillar 1992) are built on the radiographic progression Perthes described here. Flattening of the superior epiphysis advancing to near-complete epiphyseal loss with secondary acetabular remodeling.