Legg-Calve-Perthes disease
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Legg-Calve-Perthes disease is a condition that occurs in childhood and affects the hip joint. It is characterized by a temporary interruption of the blood supply to the femoral head, which is the ball-shaped part of the hip joint. As a result of this interruption, the bone begins to die.
The affected bone becomes fragile and eventually breaks apart. Over time, the bone may lose its round shape, leading to various hip joint problems. The ball recovers after the body gradually restores blood flow to it. However, if the ball is no longer round once it has healed, it may result in pain and stiffness. The renewal process of loss and fracture may take several years.
Perthes disease is a rare condition that affects one in 10,000 children between the ages of four and eight, but it can also affect children as young as two or as old as twelve. Up to 15% of children have problems with both hips.
Doctors utilize a range of procedures that keep the ball of the joint snug in the socket portion of the joint in order to maintain the ball as round as feasible. During the healing process of Legg-Calve-Perthes disease, the socket of the hip joint serves as a mold for the fragmented femoral head. As the bone gradually regains its shape and strength, it conforms to the shape of the socket, which helps to restore the normal functioning of the hip joint.
Symptoms
Legg-Calve-Perthes disease signs and symptoms include:
- Pain that is better with rest but gets worse with activity
- Hip, groin, thigh or knee pain
- Hip, groin, thigh or knee stiffness
- Limited hip joint movement
- Limping
Most cases of Legg-Calve-Perthes disease only affect one hip. Both hips can be affected in some children, although usually at different times. If your child starts limping or complains of hip, groin, or knee pain, schedule a visit with your doctor. Seek emergency medical attention for your child if they have a fever or are unable to bear weight on a leg.
Causes
Legg-Calve-Perthes disease develops when the ball of the hip joint (femoral head) receives insufficient blood flow. This bone becomes brittle and prone to fracture without adequate blood supply. The brief decline in blood flow to the femoral head is still being caused by unknown factors.
Risk factors
Legg-Calve-Perthes disease risk factors include:
- Age. Although it can afflict kids of almost any age, Legg-Calve-Perthes disease often manifests between the ages of 4 and 10.
- Sex. Boys are nearly four times more likely than girls to have Legg-Calve-Perthes.
- Race. Black children are less likely than white to experience the disease.
- Genetic mutations. Legg-Calve-Perthes disease appears to be connected to gene alterations in a small group of patients. Further research is required.
Diagnosis
Your child’s legs may be rotated into various positions during the physical examination to examine range of motion and determine which positions hurt.
Imaging tests
These tests, which are essential for determining the presence of Legg-Calve-Perthes disease, may consist of:
- X-rays. Initial X-rays could appear normal since Legg-Calve-Perthes disease-related abnormalities do not always show up on them for one to two months after symptoms first appear. Your doctor may advise having multiple X-rays taken over time to monitor the disease’s progression.
- Magnetic Resonance Imaging (MRI). This technology creates specific images of the bone and soft tissue inside the body by utilizing radio waves and a strong magnetic field. Although they are not always necessary, MRIs can frequently show Legg-Calve-Perthes disease-related bone deterioration more clearly than X-rays can.
Treatment
The entire process of bone death, fracture, and rebuilding may take several years in Legg-Calve-Perthes disease. The recommended forms of treatment will depend on the disease stage, extend of hip damage, and your age when you first noticed the symptoms.
The femoral head, which serves as the ball of the joint, weakens and fragments as the Legg-Calve-Perthes disease worsens. The socket portion of the joint can act as a mold throughout the healing process to help the broken femoral head maintain its round form.
The femoral head must be securely seated inside the socket for this molding to work. Sometimes, a special leg cast that keeps the legs widely spaced apart for four to six weeks can help this.
Some kids need surgery to help maintain the joint’s ball secure inside its socket. To realign the joint, this technique may entail creating wedge-shaped cuts in the thigh bone or pelvis.
Younger children (under the age of 6) typically don’t require surgery. The hip socket is more naturally malleable in this age group, thus the ball and socket usually continue to fit together effectively without surgery.
Other treatments
Young children in particular may require observation or conservative therapies. Conservative therapies may consist of:
- Activity restrictions. Avoid high-impact activities like running and jumping that could worsen hip deterioration.
- Crutches. Crutches can aid in protecting the joint. Your child might occasionally need to refrain from putting any weight on the hip that is injured.
- Physical therapy. The muscles and ligaments surrounding the hip may shorten as it becomes stiffer. Exercises that stretch the hip can maintain its flexibility.
- Anti-inflammatory medications. To relieve pain, ibuprofen or naproxen sodium may be prescribed by your doctor.
