Legg-Calvé-Perthes Disease

Nearly a century ago, Perthes disease was described as a form of childhood arthritis that affected the hips.

Although it is still called a disease, it recognized today as a condition in which there is a temporary loss of blood supply to the hip. This causes some or all of the femoral head of the hip joint to die. Irritation develops as a result.

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Symptoms

The signs of Perthes disease may develop slowly over weeks or even months. A child may start limping and complaining of mild pain. Sometimes this pain is caused by muscle spasms due to the irritation of the joint. The pain may be felt in other parts of the leg such as the groin, thigh or knee. When the hip is moved, the pain worsens. Rest and anti-inflammatory medication often relieves the pain.

Causes and Risk Factors

Perthes disease usually is seen in children two to 12 years old. It is five times more common in boys than girls.

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Diagnosis

Perthes is generally diagnosed by an X-ray. Increased density of the femoral head or collapse may be present.

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Treatments

Treatment of Perthes disease will vary depending on the child's age and severity of the disease. The child will have a series of X-rays taken to monitor the disease and any impact of treatment.

Treatment for children with minimal changes visible on X-rays often will be observed. Treatment for older children is sometimes more aggressive to preserve the child's range of hip motion.

Treatment focuses on three elements:

  • Reducing the irritation in the hip joint with anti-inflammatory medications such as ibuprofen
  • Restoring range of motion of the hip with physical therapy and exercises.
  • Casting with the legs apart (a Petrie cast) may be needed if the femoral head does not sit deeply in the socket. If this is the case, surgery is often needed.

When surgery is needed, the upper end of the femur may be tilted down to direct the head of the femur deeper into the socket, or the pelvis bone may be moved over the top of the femoral head.

After surgery, the child will participate in physical therapy with protected weight bearing of the affected leg until X-rays reveal the final stages of the healing are under way.

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