Nuevas estrategias de diagnóstico y tratamiento en la enfermedad de Perthes

Abstract

Perthes disease is an avascular osteonecrosis of the femoral head that primarily affects children. It is a condition with long-term risks. The incidence is higher in males with different regional variations. This review focuses on recent innovations in diagnosis and treatment for more timely treatment. Diagnosistically, non-contrast magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences has been implemented, allowing for early detection of changes in the femoral epiphysis. In addition, perfusion MRI (pMRI) and quantitative T2 and T1ρ mapping provide valuable information on blood perfusion and epiphyseal cartilage quality. Furthermore, biomarkers such as CD31+/CD42b-EMPs and IL-6 are useful for assessing vascular health and inflammation. Based on various articles, proposed treatment techniques include surgical interventions. Triple osteotomy, proximal femoral osteotomy, and containment osteotomy have been shown to improve joint congruency in the affected hip. Moreover, biological therapies using growth factors and stem cells, along with immunomodulators, offer promising prospects for bone tissue regeneration and modulation of the inflammatory response. The main conclusion is that combining new diagnostic methods with advanced therapies can significantly improve the short- and long-term outcomes in Perthes disease, optimizing clinical management and patients' quality of life.