Legg-Calve-Perthes Disease

Overview

Legg-Calve-Perthes (LEG-kahl-VAY-PER-tuz) disease is a childhood condition that occurs when blood supply to the ball part (femoral head) of the hip joint is temporarily interrupted and the bone begins to die.

This weakened bone gradually breaks apart and can lose its round shape. The body eventually restores blood supply to the ball, and the ball heals. But if the ball is no longer round after it heals, it can cause pain and stiffness. The complete process of bone death, fracture and renewal can take several years.

To keep the ball part of the joint as round as possible, doctors use a variety of treatments that keep it snug in the socket portion of the joint. The socket acts as a mold for the fragmented femoral head as it heals.

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 of the hip joint
• Pain that worsens with activity and improves with rest

Legg-Calve-Perthes disease usually involves just one hip. Both hips are affected in some children, usually at different times.

When to see a doctor

Make an appointment with your doctor if your child begins limping or complains of hip, groin or knee pain. If your child has a fever or can't bear weight on the leg, seek emergency medical care.

Causes

Legg-Calve-Perthes disease occurs when too little blood is supplied to the ball portion of the hip joint (femoral head). Without enough blood, this bone becomes weak and fractures easily. The cause of the temporary reduction in blood flow to the femoral head remains unknown.

Risk factors

Risk factors for Legg-Calve-Perthes disease include:

• Age. Although Legg-Calve-Perthes disease can affect children of nearly any age, it most commonly begins between ages 4 and 10.
• Your child's sex. Legg-Calve-Perthes is about four times more common in boys than in girls.
• Race. White children are more likely to develop the disorder than are black children.
• Genetic mutations. For a small number of people, Legg-Calve-Perthes disease appears to be linked to mutations in certain genes, but more study is needed.

Complications

Children who have had Legg-Calve-Perthes disease are at higher risk of developing hip arthritis in adulthood — particularly if the hip joint heals in an abnormal shape. If the hipbones don't fit together well after healing, the joint can wear out early.

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 at the time of diagnosis, the better the chances for the hip joint to heal in a normal, round shape.

Diagnosis

During the physical exam, your doctor might move your child's legs into various positions to check range of motion and see if any of the positions cause pain.

Imaging tests

These types of tests, which are vital to the diagnosis of Legg-Calve-Perthes disease, might include:

• X-rays. Initial X-rays might look normal because it can take one to two months after symptoms begin for the changes associated with Legg-Calve-Perthes disease to become evident on X-rays. Your doctor will likely recommend several X-rays over time, to track the progression of the disease.
• MRI. This technology uses radio waves and a strong magnetic field to produce very detailed images of bone and soft tissue inside the body. MRIs often can visualize bone damage caused by Legg-Calve-Perthes disease more clearly than X-rays can, but are not always necessary.

Treatment

In Legg-Calve-Perthes disease, the complete process of bone death, fracture and renewal can take several years. The types of treatment recommended will depend on the:

• Age when symptoms began
• Stage of the disease
• Amount of hip damage

As Legg-Calve-Perthes disease progresses, the ball part of the joint (femoral head) weakens and fragments. During healing, the socket part of the joint can serve as a mold to help the fragmented femoral head retain its round shape.

For this molding to work, the femoral head must sit snugly within the socket. Sometimes this can be accomplished with a special type of leg cast that keeps the legs spread widely apart for four to six weeks.

Some children require surgery to help keep the ball of the joint snug within the socket. This procedure might involve making wedge-shaped cuts in the thigh bone or pelvis to realign the joint.

Surgery usually isn't needed for children younger than 6. In this age group, the hip socket is naturally more moldable, so the ball and socket typically continue to fit together well without surgery.

Other treatments

Some children, particularly very young ones, might need only conservative treatments or observation. Conservative treatments can include:

• Activity restrictions. No running, jumping or other high-impact activities that might accelerate hip damage.
• Crutches. In some cases, your child may need to avoid bearing weight on the affected hip. Using crutches can help protect the joint.
• Physical therapy. As the hip stiffens, the muscles and ligaments around it may shorten. Stretching exercises can help keep the hip more flexible.
• Anti-inflammatory medications. Your doctor might recommend ibuprofen (Advil, Motrin, IVothers) or naproxen sodium (Aleve) to help relieve your child's pain.

Preparing for your appointment

You'll probably first bring your concerns to the attention of your child's doctor. After an initial evaluation, your child might be referred to a doctor who specializes in bone problems in children (pediatric orthopedist).

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

• When did these symptoms begin?
• Does a particular leg position or activity make the pain worse?
• Did any of your relatives have similar symptoms when they were children?
• Does your child have any other medical problems?
• What medications or supplements does your child take regularly?

What to expect from your doctor

Your doctor might ask some of the following questions:

• What are your child's symptoms?
• Have they gotten worse over time?
• Do the symptoms seem to come and go?
• Is your child active?
• Has your child had 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?