From the Guidelines
Legg-Calve-Perthes disease is a childhood hip disorder caused by disruption of blood flow to the ball of the femur (femoral head), leading to bone death (avascular necrosis). This condition typically affects children between ages 4-10, predominantly boys 1. The management of Legg-Calve-Perthes disease involves a multidisciplinary approach, with treatment depending on the child's age and disease severity.
Key Considerations
- The goal of treatment is to keep the femoral head properly positioned in the hip socket while healing occurs
- For mild cases, observation and activity restriction may be sufficient, with physical therapy to maintain hip motion and strengthen surrounding muscles often recommended
- Anti-inflammatory medications like ibuprofen can help manage pain, with a typical dose of 10mg/kg every 6-8 hours
- More severe cases may require bracing, such as a Scottish Rite orthosis, to keep the hip properly positioned
- In advanced cases, surgery might be necessary, including procedures to reshape the hip socket (osteotomy) or remove bone fragments
Disease Progression and Follow-up
- The disease typically resolves over 2-4 years as new bone replaces the damaged tissue
- During healing, it's crucial to follow medical advice regarding activity limitations to prevent complications like early arthritis
- Regular follow-up with an orthopedic specialist is essential to monitor healing progress and adjust treatment as needed, as seen in the management of other orthopaedic conditions such as developmental dysplasia of the hip (DDH) and clubfoot 1.
From the Research
Definition and Overview of Legg-Calve-Perthes Disease
- Legg-Calve-Perthes disease (LCPD) is a rare avascular osteonecrosis of the proximal femur, typically occurring in children between 4 and 10 years of age 2, 3, 4.
- The disease is characterized by the interruption of blood supply to the capital femoral epiphysis, resulting in necrosis of the epiphysis 5.
- LCPD can lead to long-term disability, affecting a child's physical, mental, and social development, often presenting as a painless limp 3.
Causes and Risk Factors
- The cause of ischemia leading to necrosis of the femoral head remains unknown 2.
- The etiology of LCPD is believed to be related to variations in the femoral head vascular supply, trauma, coagulation, or endocrine disturbances 6.
- The disease has a familiar pattern, with boys being more commonly affected than girls 6.
Symptoms and Diagnosis
- LCPD commonly presents with limping and pain localized in the hip, with projection to the thigh and knee, frequently accompanied by limitation of abduction and internal rotation 6.
- Plain radiography is the most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage, and the extent of disease 6.
- Diagnosis can also involve MRI or hip joint arthrography to provide additional details for management 3.
Treatment Options
- Management of LCPD is individualized and includes non-operative care to surgery, which attempts to correct anatomical abnormalities and delay the onset of osteoarthritis 3.
- Surgical treatment options depend on the patient's age at onset, the stage, and severity of the disease, and may include containment-restoring procedures such as femoral varus osteotomy (FVO), Salter's innominate osteotomy (SIO), and triple pelvic osteotomy (TPO) 2, 4.
- Non-containment-restoring procedures, such as femoral valgus extension osteotomy or trochanter apophyseodesis, may be used in later stages of the disease to help with symptom relief or restore anatomical and biomechanical features 2.