• Call us (213) 742-1000
  • donate

Legg-Calve-Perthes Disease

Perthes Disease is an inflammation and irritation to the femoral head. This is due to a loss of blood supply to the femoral head (ball of the thigh bone) for which the cause is unknown. The term ‘disease’ is used because there are several complex stages that Perthes disease passes through.

The disease process can be lengthy until the child returns to normal activities, averaging 18–24 months. Perthes disease is common between the ages of 4–10 and occurs approximately in 1 in 10,000 children. Perthes is also more common in boys than girls, but females tend to have more of an extensive involvement.

What are the symptoms?

The most common symptom seen in children with Perthes is limping. The child also may complain of mild pain in the hip joint. These symptoms may occur over weeks to months and may be intermittent. Pain may also occur in other parts of the leg including the thigh and knee.

How is it Diagnosed?

Perthes Disease is usually diagnosed using a radiograph and several should be taken throughout the process.

STAGES:

I. Early/Necrosis: Blood supply to the femoral head is interrupted and the hip joint becomes inflamed, stiff and painful. Portions of the bone die and the ball becomes less round. This stage lasts several months to a year.
II. Fragmentation: Fragmenation and reabsorption of bone to begin remodeling the round ball shape. Lasts 1–3 years.
III. Reossification: When new bone has regrown and continues to model into the round shape.  Lasts 1–3 years.
IV. Remodeling: Healing, when new bone finishes reshaping. Can last a few years.

What are the treatment options?

General treatment principles are to maintain movement in the hip and to keep the femoral head contained in the acetabulum (the socket of the hip). Depending on the patient’s age, this may be achieved with activity modification, physical therapy, casting or bracing, and/or surgery to redirect the femoral head and/or acetabulum.

Observation
If the child is young, 2–6 years of age, and there are minimal changes of the hip, the child will only need to be observed, while older children will need more intervention to preserve motion of the hip.

Nonsurgical Treatment
Medication, such as Ibuprofen is used to decrease inflammation of hip joint. It may be used for several months. If the child is already presenting with a limp and stiffness of the hip, the child may require crutches and partake in physical therapy to improve the motion of the affected hip. If the motion of the hip becomes limited or radiographs show progressive deformity, a special cast may be used to keep the head of the femur in the proper position in the hip joint.

Surgical Treatment
Surgery may be needed in severe cases to realign and place the hip back in the proper position. This is done with screws and plates which will be removed at a later time. Other surgeries may include a procedure to redirect or contain the upper part of the thigh bone (femur) in the socket to help maintain the roundness of the upper end of the femur. The patient again will be placed into a cast from chest to toes for 6–8 weeks. After the cast is removed, the child will participate in physical therapy to regain motion of the hip.