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Legg-Calve-Perthes disease

Definition

Legg-Calve-Perthes disease is when the ball of the thighbone in the hip doesn't get enough blood, causing the bone to die.

Alternative Names

Coxa plana; Perthes disease

Causes, incidence, and risk factors

Legg-Calve-Perthes disease usually occurs in boys 4 - 10 years old. There are many theories about the cause of this disease, but little is actually known.

Without enough blood to the area, the bone dies. The ball of the hip will collapse and become flat. Usually only one hip is affected, although it can occur on both sides.

The blood supply returns over several months, bringing in new bone cells. The new cells gradually replace the dead bone over 2 - 3 years.

Symptoms

The first symptom is often limping, which is usually painless. Sometimes there may be mild pain that comes and goes.

Other symptoms may include:

Signs and tests

During a physical examination, the health care provider will look for a loss in hip motion and a typical limp. A hip x-ray or pelvis x-ray may show signs of Legg-Calve-Perthes disease. An MRI scan may be needed.

Treatment

The goal of treatment is to keep the ball of the thighbone inside the socket. Your health care provider may call this "containment." The key to doing this is to make sure the hip has good range of motion. In some cases, bracing is used to help with containment.

Physical therapy and anti-inflammatory medicine (such as ibuprofen) can relieve stiffness in the hip joint. When the hip is painful, or the limp gets worse, restricting activities such as running may help reduce the inflammation. Nighttime traction may also help.

Health care providers no longer recommend several months of bedrest.

When these steps fail, surgery may be needed. Surgery ranges from simple lengthening of a groin muscle to major hip surgery to reshape the pelvis. The type of surgery depends on the severity of the problem and the shape of the ball of the hip joint.

It is important to have regular follow-up with your doctor and an orthopaedic specialist.

Expectations (prognosis)

The outlook depends on the child's age and the severity of the disease. In general, the younger the child is when the disease starts, the better the outcome.

Children younger than 6 years old who receive treatment are more likely to end up with a normal hip joint. Children older than age 6 are more likely to end up with a deformed hip joint, despite treatment, and may later develop arthritis.

Complications

Osteoarthritis may develop later in life. Early recognition and proper treatment of Legg-Calve-Perthes disease may minimize this complication.

Calling your health care provider

Call for an appointment with your health care provider if a child develops any symptoms of this disorder.

References

Gough-Palmer A, McHugh K. Investigating hip pain in a well child. BMJ. 2007;334:1216-1217.

Hosalkar HS, Horn D, Friedman JE, Dormans JP. The hip. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 677.


Review Date: 9/16/2010
Reviewed By: Sameer Patel, MD, Assistant Professor of Pediatrics, Columbia University, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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