Kohler’s disease is one of the diseases classified as sterile bone necrosis. It can occur – as has been found so far – in about 40 places.
Kohler’s disease has many varieties, but the most common diagnosis is femoral necrosis, which is called Perthes disease. Another popular one is Kohler I disease, which is a sterile necrosis of the navicular bone of the foot.
It most often attacks between the ages of 3 and 12. Boys get sick more often than girls.
The causes of the disease
They are not exactly known. Experts believe that the disease begins to develop when a small sub-cartilage necrotic area develops, which is formed when the area is ischemic. Pathogenic factors are not involved in the development of the disease, as is the case, for example, in inflammatory bone disease, when the disease is caused by staphylococcus aureus or streptococcus. Ischemia is believed to occur as a result of an inherited predisposition, bone overload, microtraumas, hormonal disorders and embolism, or ischemia due to pressure on blood vessels.
Bone blood supply disorders often occur in the period of rapid growth of children and adolescents, because the body cannot keep up with the production of proper connections between the epiphyseal and epiphyseal circulation. And although in a young organism, rapid bone remodeling promotes the regeneration of the necrosis area, bone deformation may occur, which will manifest itself in early degenerative changes.
symptoms
The most characteristic symptom is pain that increases with physical activity and disappears when you rest. In the first stage of the disease, there are no changes in the radiographic image of the affected bone. As the condition progresses, the pain becomes more severe. Pain often causes a limp when walking. Another symptom may be limited joint mobility and swelling.
The basis for the diagnosis of the disease is the taking of X-rays that will show necrotic foci.
Treatment
It consists in eliminating the symptoms of the disease, i.e. relieving pain, reducing loads and using tailored insoles for shoes. The patient should be under the constant care of an orthopedist who will monitor the progress or stoppage of the disease. This is important because without medical attention and preventive measures, severe bone destruction may occur, requiring surgical intervention. The patient must avoid overloading the bone or joint to prevent deformation. It is often recommended to wear special orthoses or to support yourself on crutches.
Long bone necrosis heal better. In the case of joint bones, treatment is lengthy and not always successful as rebuilding the cartilage is not easy.
Aseptic bone necrosis in adults
The condition can develop as a complication of rheumatic diseases such as rheumatoid arthritis and lupus erythematosus. People who take glucocorticosteroids for a long time and those who abuse alcohol are also at risk of osteonecrosis.
The symptom of necrosis may be radiating pain, which worsens when the bone is loaded. Pain does not go away with rest.
In the case of adults, there are four phases in the development of the disease. Pain appears in the first phase, but there are no characteristic changes in the X-ray image. In the second phase, the bone tissue thickens and forms characteristic foci that are clearly visible in the X-ray. The third phase of the disease is when necrotic tissue separates from healthy bone. The fourth phase is characterized by significant distortions, narrowing of the joint space and the visualization of significant swellings and unevenness on the surface of the joints.
Tekst: Anna Jarosz