Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease is a condition affecting children in which the blood supply to the ball-and-socket joint of the hip, which is located at the meeting point of the thighbone (femur) and pelvis is interrupted.

This results in the degradation of the bone and reduces its healing capacity. To keep the ball part of the joint as round as possible, doctors may use a variety of treatments to keep it snug in the socket portion of the joint. The socket acts as a mold for the fractured femoral head as it heals.

Signs and symptoms of Legg-Calve-Perthes disease include:

• Limping Pain or stiffness in the hip, groin area, thigh or knee
• Limited range of motion of the hip joint

A person needs to consult a doctor if your child begins limping or complains of hip, groin or knee pain. The child needs emergency care if he/she has a fever and can't bear weight on the leg.

Low blood supply to the ball portion the hip joint (femoral head) is the main reason which causes Legg-Calve-Perthes disease.

The insufficient blood supply makes the bone unstable, easily breakable and lowers its healing power.

The actual cause for the reduction of blood flow is still unknown. Legg-Calve-Perthes disease usually affects just one hip but in some children both hips are affected, usually at different times.

Making a diagnosis of Legg-Calve-Perthes disease is done during physical exam and by several tests.

A person should bring their child’s problem under the notice of a doctor, who may further refer you to the specialist in bone problems in children (pediatric orthopedist) if needed.

First, the doctor can ask certain questions to get the idea about the symptoms and severity of the disease.

Doctor may ask following questions:

• What abnormal symptoms you have noticed?
• What is their severity over time?
• Is the child active?
• Has your child met with any accident or injury?
• What is the actual location of the pain?

Then the doctor will perform a physical exam in which he will move the leg to various positions to check whether any position causes pain.

Doctor can also opt for various visual tests like:

• X-rays: At the initial stage the X-ray image will show normal conditions, therefore, the doctor will recommend you to have several X-rays periodically.
• Magnetic resonance imaging (MRI): MRI is a technique which uses radio waves and a strong magnetic field producing a detailed image of the bone and soft tissues. It can also measure the damage caused to the bone due to Legg-Calve-Perthes disease.
• Bone scan: This test involves injecting a radioactive dye into the vein. After some time, the dye travels to the bones through the blood stream. Bone images are then taken by a radioactive camera.

The main goal of the treatment in case of Legg-Calve-Perthes disease is to keep the ball part of the joint round. Surgical methods are usually not needed for younger children as they are at the developing stage and can repair the damage caused by the disease. The doctor may ask you for careful observation of the child and will suggest symptomatic treatment with exercises or medications as needed.

The doctor may ask you for careful observation of the child and will suggest symptomatic treatment with exercises or medications as needed. Other nonsurgical treatments include:

Other nonsurgical treatments include:

Physical therapy

• Stretching exercises which can help in reducing the stiffness of the bone and keeping the hip more flexible and snug in the socket.
• Crutches: There arises a situation when your child may need to avoid bearing weight on the affected parts, in such situation crutches are recommended to protect the joints.
• Traction: When your child feels severe pain bed rest and traction (a steady and gentle pulling force on your child's leg) are the options.
• 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. After this, a night-time brace is sometimes used to maintain hip flexibility.

Surgical procedures

Most of the orthopedic treatments for Legg-Calve-Perthes disease are aimed at improving the shape of the hip joint to prevent arthritis later in life.

• Contracture release: Children who have Legg-Calve-Perthes disease often prefer to hold their leg across the body. This tends to shorten nearby muscles and tendons, which may cause the hip to pull inward (contracture). Surgery to lengthen these tissues may help to restore the hip's flexibility.
• Joint realignment: For children older than 6 to 8 years, realignment of the joint has been shown to restore a more normal shape of the hip joint. This involves making surgical cuts in the femur or pelvis to realign the joints. The bones are held in place with a plate while the bone heals.
• Removal of excess bone or loose bodies: In older children having painful, restricted motion, trimming extra bone around the femoral head or repairing damaged cartilage may ease motion and relieve pain. Thus, loose bits of bone or torn flaps of cartilage are removed.
• Joint replacement. Children who have had Legg-Calve-Perthes sometimes require hip replacement surgery later in life. These surgeries can be complicated because of a higher risk of bone fracture and nerve damage.

A few alternative remedies exist for managing the symptoms of Legg-Calve-Perthes disease.

Home care measures to reduce pain and prevent damage include:

• Activity modification: the child should avoid high-impact activities, such as running or jumping as these can lead to increased damage to the weakened bone and worsen the symptoms.
• Pain medication: certain medications like acetaminophen (Tylenol, others) can help relieve pain. Don't give your child aspirin as it's been linked to a rare, but serious, condition called Reye's syndrome.
• Heat or cold: Hot packs or ice may help relieve hip pain associated with Legg-Calve-Perthes disease. Using heat before stretching exercises can help loosen tight muscles

There are several risks and complications associated with Legg-Calve-Perthes disease. Risks include:

• Age: the disease is most commonly seen in the age group between 4 and 8 and five times more common in boys than girls.
• Race: Caucasian children are more likely to develop the disorder.
• Family history: In rare cases family history matters. Children with this disease are more likely to have arthritis in adulthood, particularly in hip joints. If the hip bones don't fit together well after healing, the joint may wear out early and hip replacement surgery eventually may be required.

In general, children who are diagnosed with Legg-Calve-Perthes after age 6 are more likely to develop hip problems later in life. The younger the child is, the better the chances for the hip joint healing with a normal, round shape.