Legg-Calve-Perthes disease

What is Legg-Calve-Perthes Disease?

Legg-Calve-Perthes disease is a childhood condition characterized by the temporary interruption of blood supply to the femoral head, the ball part of the hip joint. This condition can lead to the death of the bone tissue, which weakens the structure and may alter its round shape. The body typically restores blood flow over time, allowing the bone to heal; however, if the femoral head heals in an irregular shape, it can result in long-term pain and limited mobility.

During the healing process, which can span several years, the fragmented femoral head can collapse if not properly supported. The hip socket acts as a mold, helping maintain the shape of the femoral head while it regenerates. Thus, effective treatment is crucial to ensuring the best possible recovery outcome.

Symptoms

Symptoms of Legg-Calve-Perthes disease generally manifest shortly after the onset of reduced blood flow. Common indicators include:

  • Limping: Often the first noticeable symptom, typically due to discomfort in the affected hip.
  • Pain or Stiffness: This may occur in the hip, groin, thigh, or even the knee, and often worsens with physical activity.
  • Limited Range of Motion: Difficulty moving the hip can be observed during physical examinations.
  • Fatigue During Activity: Children may tire more easily, especially during play or other physical exertion.

Legg-Calve-Perthes disease typically affects one hip, though both hips may be involved at different times.

Causes

The exact cause of Legg-Calve-Perthes disease remains unclear, but it is fundamentally associated with reduced blood supply to the femoral head. This lack of circulation leads to bone weakness and eventual collapse.

Risk Factors

Several factors may increase the likelihood of developing this condition:

  • Age: Most commonly, Legg-Calve-Perthes disease occurs in children between the ages of 4 and 10.
  • Sex: Boys are affected approximately four times more than girls.

Complications

If not addressed, Legg-Calve-Perthes disease can lead to complications later in life, including:

  • Arthritis: Adults who have had the condition may be at increased risk for hip arthritis, particularly if the hip joint did not heal properly.
  • Joint Wear: A poorly shaped femoral head can cause the joint to wear out prematurely.

Generally, the earlier the diagnosis is made, the better the prognosis, especially for children diagnosed before the age of six.

Diagnosis

Diagnosis of Legg-Calve-Perthes disease typically begins with a thorough physical examination. Healthcare professionals will assess the child’s range of motion and may manipulate the legs to identify pain or stiffness.

Imaging Tests

The following imaging techniques are instrumental in diagnosing the condition:

  • X-rays: While initial X-rays may not show changes, repeated imaging over time will help track the progression and changes associated with the disease.
  • MRI: This technology provides detailed images of bone and soft tissue, often revealing more information about bone damage compared to X-rays.

Treatment Options

The healing process for Legg-Calve-Perthes disease can be lengthy, often requiring several years. Treatment strategies are based on factors such as the child’s age, the stage of the disease, and the extent of hip damage.

Surgical Options

For cases that do not improve with conservative measures, surgical intervention may be necessary:

  • Casting: A specialized leg cast may be used to maintain the femoral head’s position in the socket during the healing phase.
  • Aligning the Joint: In more severe cases, surgical procedures may involve making cuts in the thighbone or pelvis to ensure proper alignment and snug fit of the femoral head within the socket.

Generally, surgery is less common in children under six due to their more pliable hip structures.

Non-Surgical Treatments

  • Activity Restrictions: Children are typically advised to avoid high-impact activities like running or jumping to prevent further joint damage.

  • Use of Crutches: In cases where weight-bearing on the affected hip is painful, crutches can help reduce stress on the joint.

  • Physical Th*rapy: Stretching exercises may be recommended to maintain flexibility in the hip and surrounding muscles, which can become stiff over time.

Legg-Calve-Perthes disease is a complex condition that requires careful monitoring and treatment. Early diagnosis and appropriate interventions can significantly improve outcomes, allowing children to lead active, fulfilling lives. Regular follow-ups with healthcare professionals experienced in managing childhood hip disorders are essential for ensuring ongoing health and mobility as the child grows.

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