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Treatments and drugs

By Mayo Clinic staff

As Legg-Calve-Perthes disease progresses, the ball part of the joint (femoral head) weakens and fractures — losing its nice round shape. The goal of treatment is to keep the femoral head as round as possible, so the hip will work properly in the future. Doctors use a variety of treatments to keep the femoral head snug in the socket portion of the joint. The socket acts as a mold for the fractured femoral head as it heals.

The length of time required for healing will vary, depending on the severity of the bone's damage. In most cases, treatment will last for two years or longer.

Therapy
If your child is 7 or younger and the femoral head is still fairly round, your doctor may suggest nonsurgical treatments such as:

• Exercises. As the hip stiffens, the muscles and ligaments around it may shorten. Stretching and strengthening exercises can help keep the hip more flexible.
• Crutches. In some cases, your child may need to avoid bearing weight on the affected hip. Using crutches can help protect the joint.
• Traction. If your child is in severe pain, a period of bed rest and traction may help. Traction involves a steady and gentle pulling force on your child's leg.
• Casts. To keep the femoral head deep within its socket, your doctor may recommend a special type of leg cast that keeps both legs spread widely apart for four to six weeks.

Surgery
Nonsurgical treatments don't work as well in children older than 7, perhaps because their bones aren't as moldable as those of younger children. Surgery may also be a better option for children with more-severe bone deformities. Surgeries used to treat Legg-Calve-Perthes disease include:

• Contracture release. Legg-Calve-Perthes and the immobility imposed by some of its treatments can shorten nearby muscles and tendons, which may cause the hip to pull inward (contracture). Surgery to lengthen these tissues may help restore the hip's flexibility.
• Loose body removal. In some children, the damage to the femoral head can result in loose bits of bone or torn flaps of cartilage. Surgically removing this misplaced tissue can help the hip joint move more smoothly.
• Hardware implants. If leg casts can't place the ball and socket in a healthy position, your doctor might suggest changing the position of the ball and socket. This may involve the use of metal hardware such as screws, wires or plates.
• Joint realignment. If the femoral head doesn't match up well with its socket, surgeons can alter the angle of the thighbone or the pelvis to bring the two bones into better alignment.

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