Perthes' disease: deprivation and decline

  title={Perthes' disease: deprivation and decline},
  author={Daniel C. Perry and Colin E. Bruce and Daniel Pope and Peter H. Dangerfield and Mary Jane Platt and Andrew James Hall},
  journal={Archives of Disease in Childhood},
  pages={1124 - 1128}
  • D. PerryC. Bruce A. Hall
  • Published 11 November 2011
  • Medicine, Psychology
  • Archives of Disease in Childhood
Introduction Perthes' disease is a childhood hip disorder which frequently precipitates premature osteoarthritis necessitating joint replacement in young adults. The highest incidence reported worldwide is in Merseyside, UK, where a unique disease register is maintained. Objective To describe the temporal trends in disease incidence in a geographically defined area of Merseyside, and to examine the relationship to area deprivation. Design Descriptive observational study utilising a regional… 

Perthes’ disease of the hip: socioeconomic inequalities and the urban environment

The occurrence of Perthes’ disease within urban environments is high, yet this appears to be a reflection of higher socioeconomic deprivation exposure and disease rates appear equivalent in similarly deprived urban and non-urban areas, suggesting that the determinant is not a consequence of the urban environment.

Unravelling the enigma of Perthes disease.

  • D. Perry
  • Medicine
    Annals of the Royal College of Surgeons of England
  • 2013
Despite a falling incidence, Perthes disease remains an important cause of child morbidity and exemplifies socioeconomic inequalities and a deprivation-related exposure, acting early in development, appears critical.

The lognormal age of onset distribution in Perthes' disease: an analysis from a large well-defined cohort.

The analysis suggests that an antenatal aetiological determinant may be responsible for disease, and Perthes' disease age of onset conforms to a lognormal model, which is most typical of infectious diseases.

The Declining Incidence of Legg-Calve-Perthes’ Disease in Northern Ireland: An Epidemiological Study

The number of new cases of LCPD is decreasing over time and the epidemiological data are unchanged between 2 cohorts over a 15-year period, and this therefore supports a change within the patients' environment relating to this decline.

Comorbidities in Perthes' disease: a case control study using the General Practice Research database.

Perthes' disease has a significant association with congenital genitourinary and inguinal anomalies, suggesting that intra-uterine factors may be critical to causation and other comorbid associations may offer insight to support or refute theories of pathogenesis.

Hyperactivity and the Psychological Burden of Perthes Disease: A Case-Control Study

There was a marked psychological burden among individuals with LCPD, which was most marked amongst individuals with a recent diagnosis, which may be a fundamental disease characteristic related directly to disease or to its etiological determinant.

The British Orthopaedic Surgery Surveillance study: Perthes’ disease

There appears to be a sufficient case volume and community equipoise among surgeons to embark on a randomized clinical trial to definitively investigate the effectiveness of containment surgery, and an optimized decision tree identified joint stiffness and age above eight years as the key determinants for containment surgery.

Epidemiology, pathogenesis, and treatment of Legg-Calvé-Perthes disease: current concepts

Experimental studies suggest that modulation of osteoclastic function prevents femoral head collapse, and a clearer separation of treatment into preventive treatment, remedial treatment, and salvage based on the timing of intervention during the course of the disease has emerged.

Aetiology of Legg-Calvé-Perthes disease: A systematic review

The literature available on the aetiology of LCPD presents major limitations in terms of great heterogeneity and a lack of high-profile studies, so more studies are needed to understand the complex and multifactorial genesis of the avascular necrosis characterizing the disease.

The epidemiology of transient synovitis in Liverpool, UK

The normal distribution for age at disease presentation suggests a specific disease entity, though transient synovitis remains an enigma, and the absence of seasonality casts some doubt on the popular theory of a viral aetiology.



A profile of Perthes' disease in Greater Glasgow: is there an association with deprivation?

The demographic data of a group of 240 children who presented with Perthes' disease in Greater Glasgow, where the mean deprivation scores are substantially greater than in the rest of Scotland, were examined to see if this association applied and whether other clues to the aetiology of Perthers' disease could be found.

The incidence and distribution of Legg–Calvé–Perthes' disease in Liverpool, 1982–95

It is suggested that environmental influences may come into play some years before a child presents with pain in the hip, and there may be a genetic predisposition to the disease.

The epidemiology and aetiology of Perthes' disease in Norway. A nationwide study of 425 patients.

The findings point toward a single cause, either genetic or environmental, acting prenatally in the aetiology of Perthes' disease, which was undertaken over a five-year period from January 1996.

Perthes' disease of the hip in Liverpool.

Analysis of all new cases that occurred in Liverpool and adjacent parts of Knowsley and Sefton during 1976-81 showed a steep gradient with social class, which supports the hypothesis that undernutrition is a causative factor in the disease.

The epidemiology of Perthes' disease in south India.

There is a marked geographical variation in the incidence of Perthes' disease in south India, the disease being much more common in the western coastal region than elsewhere and the age of onset was significantly higher than that reported from England.

The incidence of Perthes' disease in Korea: a focus on differences among races.

The mean annual incidence of Perthes' disease in Korea is similar to that reported in other Asian countries, but higher than in black populations and lower than in Caucasians.

The incidence of Perthes' disease in three population groups in the Eastern Cape region of South Africa.

  • N. A. Purry
  • Medicine
    The Journal of bone and joint surgery. British volume
  • 1982
The incidence of Perthes' disease in white children aged 14 years and under, in coloured children and in black children during the five-year period 1975 to 1979 was 10.8 per 100 000, while the incidence in the metropolitan area of Port Elizabeth was roughly twice that in the rural part of the region.

Perthes' disease of the hip in three regions of England.

The ratio of male to female incidence varied between the regions as did the age distribution of male cases, pointing to the importance of environmental factors in the aetiology of the disease, and the need for further epidemiological studies.

Deprivation, urbanisation and Perthes' disease in Northern Ireland.

While the incidence of Perthes' disease was found to be associated with indicators of the level of deprivation for areas, there was no evidence to suggest that there was an increased risk in urban areas; the highest rate was found in the most deprived rural category.

Low blood manganese levels in Liverpool children with Perthes' disease.

In Liverpool, which has the highest incidence of Perthes' disease reported anywhere in the world, children with the disease were shown to have lower blood manganese levels than controls, evidence that manganae deficiency around the time of birth may be a cause of the disease.