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Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease

Description

Legg-Calvé-Perthes disease (Perthes) is a condition where blood flow to the ball (femoral head) of the hip joint is disrupted. There are many theories regarding the cause of this disease, but it is largely unknown why the blood flow to the hip is compromised. The absence of an adequate blood supply triggers a process called avascular necrosis, which is where bone cells die.

Perthes disease progresses through a series of stages that can take place over the course of several years. Over time, the weakened femoral head (the "ball" of the "ball-and-socket" joint) slowly begins to break apart. Eventually, the blood supply to the femoral head returns and the bone will begin to grow back.

Treatment for Perthes focuses on helping the bone grow back into a more rounded shape that still fits into the socket of the hip joint. This will help the hip joint move normally and prevent hip problems in adulthood.

Symptoms

Changes in the way a child runs or walks is one of the earliest signs of Perthes. The child may also limp or experience a limited range of motion. Other common symptoms are:

  • Pain in the groin, hip, thigh or knee
  • Pain that gets worse with activity and subsides with rest
  • Painful muscle spasms

Evaluation

  • The physician will conduct a physical examination to assess the child's range of motion.
  • X-rays are required to confirm a diagnosis of Perthes. They will show the condition of the femoral head and help the physician to identify the stage of the disease.

Treatment

Nonsurgical treatment

  • Observation may be the initial approach, and the physician will monitor the regrowth of the femoral head.
  • Anti-inflammatory medicines such as ibuprofen are used to reduce inflammation.
  • Restricting activity will help relieve pain and protect the femoral head.
  • Physical therapy may be prescribed to help restore range of motion.
  • Casting and bracing may be utilized to keep the femoral head and the acetabulum in their normal positions.
    • In some cases, the physician may perform a tenotomy. This is done when the tightness of the adductor longus muscle in the groin is preventing the hip from rotating into proper position. This will be done to release the tightness before applying the cast.

Surgical treatment

Surgery may be recommended to re-establish proper alignment of the hip bones, and to keep the femoral head within the acetabulum while the healing process take place. An osteotomy is the most common procedure for treating Perthes. In this type of procedure, the hip is surgically repositioned to keep the femoral head firmly within the acetabulum. The alignment is secured with screws and plates, which are removed after the healed stage of the disease.