When should I consider referring a child with suspected Perthes disease to a specialist?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 17 August 2025Updated: 17 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

When considering referring a child with suspected Perthes disease to a specialist, it is important to note that Perthes disease is a key diagnosis that demands early intervention and treatment ,,. Therefore, specialist assessment is generally indicated if Perthes disease is suspected or cannot be ruled out in primary care.

You should arrange urgent specialist assessment if the child with a limp (which could be due to Perthes or another serious condition) presents with any of the following red flags:

  • Has a fever and/or other red flags suggesting serious pathology, such as pain waking the child at night, redness, swelling, or stiffness of the joint or limb ,,.
  • Exhibits weight loss, anorexia, fever, night sweats, or fatigue ,,.
  • Has an unexplained rash or bruising ,,.
  • Experiences limp and stiffness that is worse in the morning ,,.
  • Is unable to bear weight or has painful limitation of range of motion ,,.
  • Presents with severe pain, anxiety, and agitation after a traumatic injury ,,.
  • Has a palpable mass ,,.
  • Is suspected of being maltreated ,,.
  • Is younger than 3 years of age, as transient synovitis is rare in this age group and septic arthritis is more common ,,.
  • Is older than 9 years of age with painful or restricted hip movements (particularly internal rotation), to exclude slipped upper femoral epiphysis ,,.

You should arrange specialist assessment (with the urgency depending on clinical judgement) if:

  • There is uncertainty about the cause of the limp, in which case referral should be to paediatric orthopaedics or orthopaedics ,,.
  • The cause of the limp cannot be managed in primary care ,,.
  • A child presents with a limp on multiple different occasions ,,.
  • Symptoms have not resolved completely or there is any uncertainty about the diagnosis after initial primary care management (e.g., for suspected transient synovitis) .

Related Knowledge Topics

Educational content only. Always verify information and use clinical judgement.