What is Legg-Calve-Perthes Disease?

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What is Perthes Disease?

Legg-Calvé-Perthes disease, or Perthes disease, as it is usually called, is a rare condition of the hip bone that affects only children. It is characterized by a temporary loss of blood supply to the hip. The lack of an adequate blood supply causes the head of the femur bone to die. This process is called osteonecrosis.

Who gets Perthes disease?

Perthes disease is rare, afflicting about one in 1,200 children. Perthes disease usually affects children between the ages of 4 and 10. The average onset age is 6. It is five times more common in boys than in girls. It often affects children who are very active, even athletic. Fewer than 5% of children with Perthes disease are affected in both hips.

What are the causes of Perthes diseases?

The causes of Perthes disease are not known. However, children who are short for their age, or who are extremely active, may be at higher risk. The disease is also more common in Asians, Eskimos, and Caucasians. There is a much lower incidence rate in Native Americans, people with African heritage, Polynesians, and in Australian aboriginals. Exposure to secondhand smoke may also increase a child's risk of Perthes disease, although the exact reasons why are not known.

What are the symptoms of Perthes disease?

The first symptoms of Perthes disease are usually limping, or mild pain in the hip area. The child may not even notice he or she is limping. It may be the parent who first sees this while watching their child play. Pain may occur on and off for months. It may be felt in the hip, or areas around the hip, as the child compensates for lower hip mobility by overusing muscles around the hip. This pain may be in the groin, thigh, or knee. The affected area may also appear inflamed and irritated.

Sometimes, the child may feel no symptoms. Perthes disease might not be noticed until an X-ray taken due to a fall or other injury shows that the child is affected by the condition.

If your child has any of the above symptoms and you suspect he or she may have Perthes disease, you should consult your pediatrician immediately.

How is Perthes disease diagnosed?

If you child is experiencing symptoms of Perthes disease, your physician will order an X-ray. This can confirm a diagnosis in almost all cases. Your physician may also order additional studies such as an MRI to see how far the disease may have progressed.

Your physician may also use other tests to check the disease's progress. These include measuring your child's thigh to determine if there is muscle atrophy. Your physician may also have your child perform some activities to test his range of motion.

How is Perthes disease treated?

Treatment for Perthes disease depends on the stage of your child’s condition. The treatment often requires periods of immobilization and limits on normal activity.

For children between ages 2 and 6, your physician may take a wait-and-see approach.

Older children may be treated surgically or nonsurgically.

Non-surgical treatments include the use of anti-inflammatory medications, such as ibuprofen (Motrin®, Advil®), naproxen sodium (Aleve®) and physical therapy. Some children may need to walk with crutches or be prescribed bed rest during the treatment process. If the disease continues to progress, the next step may be to place the child in a cast to keep the hips in the best position for healing.

If your physician determines that your child's condition is still progressing, surgery may be required. Surgical treatment can restore the proper alignment of the hip bones. Screws, plates and/or pins may be inserted to keep them in place (these will be removed at a later time). Your child may need to be immobilized in a full-body cast for 6 to 8 weeks after surgery.

Following surgery, physical therapy will usually be required to help your child continue to heal.

Whether your child is treated surgically or non-surgically, a series of X-rays will be taken throughout the process to determine how he or she is healing.

What is the prognosis for children diagnosed with Perthes disease?

Fortunately, Perthes disease usually responds well to treatment. In most cases, after 18 months to two years of treatment, children can return to their normal activities without limitations.

Sources:

National Osteonecrosis Foundation
American Academy of Orthopaedic Surgeons
Pediatric Advisor

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/12/2010…#14587