Legg-Calve-Perthes disease fundamentals
Legg-Calve-Perthes disease is a disorder of the hip in young children. The condition was independently described by Legg, Calve, Perthes and Waldenstrom in 1910. The disease occurs when the head of the thighbone (femur) in the hip deteriorates due to insufficient blood supply to the area.
Because of the tremendous capacity for bone remodeling in children, the prognosis of this disease is much better than would be expected in teenagers or adults.
Perthes disease typically occurs in patients between the ages of 4 - 8 and is significantly more common in boys than in girls. It is present in both hips in only 12 percent of patients. There is no evidence that this is an inherited condition.
Following treatment during childhood, most patients do well into their 40s and 50s after which time there is a higher incidence of osteoarthrosis of the hip requiring arthroplasty.
What are the symptoms?
- Pain in hip, knee or pelvis
- Worsening pain at the end of the day and over time
Consider visiting a doctor if your child complains about the above conditions for more than a few days.
What are my child's treatment options?
Due to insufficient blood supply, the thighbone cells die. After bone cells die, the body replaces them with new cells. However, the bone is unstable during this re-growth period. Thus, it is important to make sure the bone does not break and then reform abnormally.
Containment of the hip is the basis of treatment. Your doctor may use a cast or brace to keep your child's leg in certain positions, while using X-rays to chart the regrowth of bone. The goals of the treatment are to minimize deformity in the thighbone and keep the head of the bone covered by the socket. The growth process typically takes between 18 and 36 months. Other non-surgical treatments include:
- Bed rest
- Physical therapy
- Anti-inflammatory medications
In some patients, a pelvic osteotomy, femoral osteotomy or combined pelvic/femoral osteotomy is required. During an osteotomy, the bone is cut below the infected area and turned so that another portion of the bone that is not affected by the disease is the new weight-bearing area.
What are the risks of surgery? Is the surgery safe?
Risks include nerve injury, infection, bleeding, and stiffness.
How does my child prepare for surgery?
- Complete any pre-operative tests or lab work prescribed by your child's doctor.
- Arrange to have someone drive your child home from the hospital.
- Do not allow your child to take aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your child's appointment time. If the surgery is being done at The Cleveland Clinic, call 216.444.0281.
What should I do the night before surgery?
Do not allow your child to eat or drink anything after midnight.
What does my child need to do the day of surgery?
- If your child currently takes any medications, have her or him take them the day of the surgery with just a sip of water.
- Do not allow your child to wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Have your child wear loose-fitting, comfortable clothing.
What happens after surgery?
Ask your surgeon for complete post-operative instructions.
How long is the recovery period after surgery?
Recovery times vary from patient to patient.
What is the rehab after surgery?
Rehabilitation is prescribed based on the patient's needs.
How will my child manage at home during recovery from the procedure?
This depends on the procedure that is performed. Your surgeon will provide you with home-going instructions.
How frequently should I schedule follow up appointments with my child's doctor following surgery?
The first post-operative appointment typically is scheduled a week to 10 days after surgery. The remainder of post-operative appointments is determined by your physician.
What are the CCF physician credentials?
All doctors at The Cleveland Clinic Department of Orthopaedic Surgery are board-certified or board-eligible in orthopaedic surgery. In addition, our surgeons have subspecialty training and years of experience in pediatric surgery.
All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
All Cleveland Clinic staff pain management specialists are board-certified or board-eligible in pain management or have the international equivalent.
How do I make an appointment?
Call 216.444.2606 or toll free 800.223.2273, ext. 42606, Monday through Friday, 8:00 a.m. to 5:00 p.m. (Eastern Standard Time).
What clinical trials and orthopaedic research are being conducted at CCF on the procedure?
Researchers at the Cleveland Clinic are involved in ongoing studies that investigate new drugs and treatment approaches for managing disease. Participants in these clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. There are currently more than 1,700 active clinical studies underway.
Are there other resources that I can go to for more information on the procedure?
Patients can go to the following resources for more information on this procedure:
- Cleveland Clinic Health Information Center
- American Academy of Orthopaedic Surgeons
Why should I seek a second opinion regarding treatment for this procedure?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.
A convenient way to obtain a second opinion is e-Cleveland Clinic, a contemporary adaptation of The Cleveland Clinic's 80-year tradition as a nationally designated referral center. An easy-to-use, secure, from-home second opinion service, e-Cleveland Clinic utilizes sophisticated Internet technology to make the skills of some of our specialists available to patients and their physicians, anytime, anywhere. With e-Cleveland Clinic's personalized access, no patient need ever to feel unsure or uninformed when faced with what could potentially be one of the most important decisions of their life.