From the Research
The initial treatment approach for a child diagnosed with Legg-Calve-Perthes disease should focus on containment of the femoral head within the acetabulum while maintaining range of motion, as this approach has been shown to improve outcomes in terms of preventing femoral head deformity and promoting healing 1. The treatment typically begins with activity modification, avoiding high-impact activities while encouraging non-weight bearing exercises like swimming.
- Physical therapy is essential to maintain hip range of motion and strengthen surrounding muscles.
- Pain management includes NSAIDs such as ibuprofen (10 mg/kg/dose every 6-8 hours) or naproxen (5-7 mg/kg/dose twice daily). For containment, depending on disease severity and age, bracing with a Petrie cast or Scottish Rite orthosis may be used.
- In more severe cases or older children (typically over 6 years), surgical intervention like femoral or pelvic osteotomy might be necessary. The goal of treatment is to prevent femoral head deformity while the avascular bone undergoes revascularization and remodeling, a process that can take 2-4 years. Regular follow-up with orthopedic specialists every 3-6 months with radiographic monitoring is crucial to assess healing progression and adjust treatment accordingly 2. Although some studies have explored the potential use of bisphosphonates in the treatment of Legg-Calve-Perthes disease, the current evidence is not sufficient to support their routine use in clinical practice 3, 4. Prognostic factors such as age at disease onset, extent of head involvement, and lateral pillar collapse should guide treatment decisions 2, 5.