Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease, often referred to as Perthes, is a condition that causes a temporary disruption of the blood supply to the top of the thigh bone – the femoral head – or the ball of the hip’s ball and socket. This leads to bone destruction phase, which is followed by a rebuilding phase. The disease usually lasts between 18 and 36 months and is most common in children between the ages of 4 and 10.

Cause

There is no known cause of Perthes disease and it is likely caused by multiple different causes that ultimately decrease blood flow to the femoral head.

Symptoms

Symptoms may occur over weeks to months and may be intermittent. Common symptoms related to Perthes disease are:

• Painless limping
• Mild hip joint pain
• Decreased hip range of motion
• Pain in the thigh or knee

Diagnosis

Perthes disease is usually diagnosed with X-ray, but MRI is sometimes ordered to confirm the severity of the disease. Several X-rays are taken throughout the course of the disease so that your child’s doctor may monitor the progression and severity of the disease. There are different stages of the disease, which your child’s doctor will monitor. These are:

• Early/Necrosis: Blood supply to the femoral head is interrupted and the hip joint becomes inflamed, stiff and painful. Portions of the bone die, and the ball becomes less round. This stage may last several months to a year.
• Fragmentation: The bone becomes fragmented as the body resorbs – clears out – the dead bone. This stage lasts 6-12 months.
• Reossification: After the dead bone is resorbed, the body begins to replace the dead bone with new bone. The bone is remodeled overtime, with the attempt to restore the natural round shape of the femoral head. This stage may last 6-18 months.
• Remodeling: The body continues to reshape the new bone over a prolonged period of time. This stage is a less-active stage and may last a few years.

Treatment 

Generally speaking, if your child is 2–6 years of age and there are minimal changes of the hip, your child’s doctor may not offer any active treatments. Your child should avoid athletic activities to protect the hip while it is going through the disease stages. His/her doctor will monitor the hip’s progress with X-rays every 6 months. If your child is older, your child’s doctor may offer more active intervention to preserve the hip joint.

Possible treatments your doctor may offer your child’s Perthes disease include:

• Activity modification – no running, jumping, athletics
• Casting, crutches or bracing
• Anti-inflammatory medications, such as ibuprofen

Surgical Treatment

Depending on your child’s age and severity, surgery may be offered. The most common procedure redirects the upper part of the thighbone (femur) into the socket to help promote and maintain the roundness of the upper end of the femur. If your child is experiencing limited range of motion, a procedure to increase the motion followed by 6-weeks of casting may be utilized. After casting, your child’s doctor will prescribe physical therapy to maintain the motion and improve function. After the course of the disease, if there is residual deformity in the femoral head, your child’s surgeon may offer surgery to reshape the femoral head or socket.

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Hip Disorders