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Legg-Calve-Perthes disease
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/legg-calve-perthes-disease/DS00654
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Definition
Legg-Calve-Perthes (LEG-kahl-VAY-PEER-tuz) disease is a childhood condition associated with an inadequate blood supply to part of the hip joint. Without adequate blood flow, a process can occur in which the bone becomes unstable, and may break easily and heal poorly.
Legg-Calve-Perthes disease typically affects one hip, but sometimes it develops in both hips. Although Legg-Calve-Perthes disease can affect children of nearly any age, it's most common among boys ages 2 to 12.
Children who develop Legg-Calve-Perthes disease when they're very young often have the best outcomes. The younger your child, the more time there is to reshape the affected hipbone. Most children with Legg-Calve-Perthes disease do well in the long term.
Symptoms
Signs and symptoms of Legg-Calve-Perthes disease include:
- Limping
- Pain or stiffness in the hip, groin, thigh or knee
- Limited range of motion
- Shortened leg on the affected side, in some children
In some cases, pain and stiffness get better when your child rests, only to reappear once your child is active again.
When to see a doctor
Talk to your child's doctor if your child:
- Begins limping
- Complains of hip, groin or knee pain
Causes
The underlying cause of Legg-Calve-Perthes disease — also known as ischemic (avascular) necrosis of the hip — isn't clear. But what happens is this: Not enough blood is supplied to the ball portion of the hip joint (femoral head). Without an adequate blood supply, the femoral head deteriorates. As dying bone cells are replaced with new cells, the bone becomes unstable, and it may break easily and heal poorly.
Risk factors
Legg-Calve-Perthes disease can affect children of nearly any age, but it's most common among boys ages 2 to 12. In fact, it's up to five times more common in boys. When girls develop Legg-Calve-Perthes disease, it tends to be more severe.
In addition, Legg-Calve-Perthes disease is most common in Asians, Eskimos and whites. The disease may be more likely in physically active children who are small for their age and in those who are exposed to secondhand smoke.
Complications
Complications of Legg-Calve-Perthes disease may include:
- Permanent hip deformity. Legg-Calve-Perthes disease may cause a permanently deformed hip joint — especially if the condition develops after ages 6 to 8.
- Increased chance of osteoarthritis. Severe cases of Legg-Calve-Perthes disease may increase the risk of osteoarthritis as an adult.
Preparing for your appointment
Make an appointment with your child's doctor if your child develops signs or symptoms common to Legg-Calve-Perthes disease. After an initial evaluation, your child may be referred to a pediatric orthopedist, a doctor who specializes in bone and muscle (musculoskeletal) problems in children.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
Information to gather in advance
- List your child's signs and symptoms, and for how long your child has had them.
- Write down your child's key medical information, including any other health problems and the names of any medications your child is taking.
- List any possible sources of trauma to your child's hip, such as an accident or sports injury.
- Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
Below are some basic questions to ask your doctor about Legg-Calve-Perthes disease. If any additional questions occur to you during your visit, don't hesitate to ask.
- Does my child have Legg-Calve-Perthes disease?
- How severe is my child's condition?
- What treatment approach do you recommend?
- If the first treatment isn't effective, what will you recommend next?
- How often should my child be seen for follow-up exams?
- What is the long-term outlook in my child's case?
- Does my child need to follow any activity restrictions? For how long?
- What can I do to help ease my child's symptoms?
- Can you recommend a local support group?
- Can you recommend educational Web sites, pamphlets or books?
What to expect from your doctor
Your doctor is likely to ask you and your child a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:
- What are your child's symptoms?
- When did you first notice these symptoms?
- Do your child's symptoms seem to come and go?
- Have your child's symptoms become worse over time?
- Is your child active?
- Has your child experienced an accident or injury that might have caused hip damage?
- If your child's symptoms include pain, where is the pain located?
- Does activity make your child's symptoms worse?
- Does resting ease your child's discomfort?
- Has your child been diagnosed with any other medical conditions?
- Is your child taking any medications?
- What else concerns you?
What you can do in the meantime
In the time leading up to your appointment, your child's symptoms may improve with short periods of rest and over-the-counter pain medications, such as ibuprofen (Advil, Motrin, others). Avoid using aspirin in children.
Tests and diagnosis
Diagnosis of Legg-Calve-Perthes disease is often based on a combination of:
- Your child's signs and symptoms
- A physical exam
- Imaging studies
Your child's doctor may recommend X-rays, magnetic resonance imaging (MRI) or bone scans to detect changes in the bones. Sometimes Legg-Calve-Perthes disease is detected incidentally during an X-ray done for other reasons.
Treatments and drugs
If your child is diagnosed with Legg-Calve-Perthes disease, he or she may be referred to a pediatric orthopedic specialist for treatment.
Treatment is designed to protect the hip from further stress and injury and keep the ball of the thighbone (femur) in the hip socket. While resting the joint may help, prolonged bed rest isn't recommended. Depending on the severity of the condition, treatment options may include:
- Anti-inflammatory medications. Over-the-counter medications such as ibuprofen (Advil, Motrin, others) can help relieve pain. They can also reduce joint inflammation when used for months at a time. The dosage may be decreased as your child's hip begins to heal. Although it is an anti-inflammatory medication, aspirin isn't recommended for use in children.
- Physical therapy. Range-of-motion exercises can help maintain joint mobility. These exercises can be done at home or with the help of a physical therapist.
- Crutches. Crutches can ease pain by keeping your child's weight off his or her hip.
- Casts, braces or traction. Temporarily immobilizing the bone can help promote healing. This may be done with leg or hip casts, leg braces or traction (applying a pulling force to the bone).
- Surgery. If a groin muscle has shortened due to excessive limping, it may be surgically released from the bone. After surgery, the affected leg is put in a cast for six to eight weeks to allow the muscle to grow to a more normal length. Sometimes the hip ball must be replaced within the socket. In other cases, the hip socket is repositioned.
Legg-Calve-Perthes disease can't be prevented. But with appropriate treatment, most children can go back to normal activities within 18 months to two years.
- Perthes disease. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00070&return_link=0. Accessed Jan. 22, 1010.
- Legg-Calve'-Perthes disease. National Osteonecrosis Foundation. http://www.nonf.org/perthesbrochure/perthes-brochure.htm. Accessed Jan. 22, 2010.
- Hosalkar HS, et al. The hip. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/179341369-5/942328489/1608/1578.html#4-u1.0-B978-1-4160-2450-7..50679-4--cesec26_12453. Accessed Jan. 22, 1010.
- Mercier LR. Legg-Calvé-Perthes disease. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/179341369-5/942328489/2088/368.html#4-u1.0-B978-0-323-05609-0..00021-6--sc0040_7585. Accessed Jan. 22, 2010.
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