From the Research
The initial treatment approach for a child diagnosed with Legg-Calve-Perthes disease should focus on pain management, maintaining hip mobility, and protecting the femoral head while it heals, with the most recent and highest quality study suggesting a multifactorial approach to treatment 1. The treatment typically begins with activity modification and non-weight bearing or partial weight bearing on the affected hip using crutches or a walker.
- Physical therapy is essential to maintain range of motion through gentle stretching exercises, which helps prevent contractures and stiffness.
- Pain management includes NSAIDs such as ibuprofen (10 mg/kg/dose every 6-8 hours) or naproxen (5-7 mg/kg/dose twice daily).
- In some cases, a period of bed rest with traction might be recommended for severe pain or spasm. Containment therapy, which keeps the femoral head deeply seated in the acetabulum, may be achieved through bracing (such as a Petrie cast or Scottish Rite orthosis) for younger children with mild to moderate disease, although the use of bracing is controversial and its effectiveness has been questioned in some studies 2. The rationale behind these interventions is to reduce mechanical stress on the healing femoral head while maintaining its spherical shape within the acetabulum, as the avascular bone is gradually replaced by new bone over a period of 2-4 years, with some studies suggesting that biological treatment strategies to improve the healing process by decreasing bone resorption and stimulating bone formation may be promising 3. Regular follow-up with orthopedic specialists is crucial to monitor disease progression and adjust treatment accordingly, taking into account the latest research and guidelines on the treatment of Legg-Calve-Perthes disease 4, 1.