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Abstract
Legg-Calve-Perthes’ disease is a temporary condition in children in which the ball-shaped head of the thigh bone, referred to as the femoral head, loses its blood supply. As a result, the femoral head collapses. The body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the femoral head of the thigh bone. Legg-Calve-Perthes disease causes the hip joint to become painful and stiff for a period of time.
The cause of Legg-Calve-Perthes disease is unknown. It occurs in approximately one out of 1,200 live births and is four times more likely to occur in boys than girls. Legg-Calve-Perthes disease commonly affects first-born children and is typically seen in children 3 to 12 years of age. While the majority of cases only affect one hip, approximately 10 to 12 percent of the cases affect both hips.
The child typically complains of pain in his/her hip that is aggravated by activity. Sometimes, they will also experience pain in their thigh or knee area. The child usually walks with a limp and reports that rest will alleviate the pain.
The two most critical factors that determine the outcome are the child’s age and how much of the femoral head is affected by this condition. The more severe the case, the greater the likelihood that the child may experience limited hip motion, differences in leg lengths, and further hip problems in adulthood.
The goal of treatment is to preserve the roundness of the femoral head and to prevent deformity while the condition runs its course. Treatment options are dependent upon the amount of hip pain, stiffness, and X-ray changes over time, as well as how much of the femoral head has collapsed.
Surgical treatment realigns the bony structures so that the head of the femur is placed deep within the acetabulum. Fixation is maintained with screws and plates that will be removed at a later date. In some cases, the socket must also be deepened because the ball actually has enlarged during the healing process and no longer fits snugly within. After either procedure, the child is often placed in a cast from the chest to the toes for 6 to 8 weeks. After the cast is removed the child will participate in physical therapy with protected weight bearing of the affected leg until X-rays reveal the final stages of the healing are under way.
In addition to understanding the basics of Perthes disease, parents are anxious to know what effect Perthes will have on their child in future years. Many long term studies have now been completed and it is the overwhelming consensus that thirty to forty years after the onset, as high as 90% of the children are active and pain free. This means they will enjoy the ability to keep up with their friends as they progress through immediate and future years. All of this, in spite of the fact that most hips do not return to normal shape, once completely healed.
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