What is Legg Calve Perthes Disease? Causes, Symptoms, and Diagnosis
Legg-Calve-Perthes disease (LCPD) is avascular necrosis (AVN) caused by a disruption in blood supply to the proximal femoral head. Approximately one out of 10,000 children suffer from Perthes disease. Children with Perthes disease are usually three to eight years of age but can be as young as two or as old as 12. The disease can develop insidiously after a hip injury. The disorder is typically symmetrical in most instances. More than 10% of hip fractures involve both hips, and the injuries often occur one after the other rather than concurrently. Let’s explore in detail what is Legg calve Perthes disease, how it can be diagnosed, and how to treat it.
What is Legg Calve Perthes Disease?
A rare childhood disease contributing to hip deformities is Perthes disease. The condition occurs when there is a temporary interruption in the blood supply to the rounded head of the femur (thighbone). As a result, bone cells die due to an inadequate blood supply and a process called avascular necrosis.
Several stages are involved over several years, even though the term “disease” is still used. The weakened femur head (the “ball” of the “ball-and-socket” hip joint) slowly begins to collapse as the condition progresses.
After some time, blood flow to the head of the femur has returned, and the bone grows back.
Treatment for Perthes involves rounding out the bone and reshaping it to fit more comfortably in the hip’s socket. Having a healthy hip joint will prevent hip problems in adulthood. Most children with Perthes have a good long-term prognosis. The majority of children can resume their daily activities within 18 to 24 months of treatment.
Causes of Legg Calve Perthes
Legge-Calve-Perthes disease develops when the ball portion of the hip joint (femoral head) does not receive enough blood supply. Blood depletes bones, causing them to be weak and prone to fracture. This disease is currently incurable. It can result from trauma that damages the blood vessels or disorders that cause the blood to clot in the veins and clog up.
Symptoms of Legg Calve Perthes
A child’s way of walking and running changes the moment are one of the signs of Perthes. During sporting events, this is most evident. The irritability in the hip joint may leave your child limping, limited in their motion, and creating an unusual running style.
Symptoms that are common include:
- There may be pain in your hip, groin, or other parts of your leg, including the thigh or knee.
- An injury resulting from activity that goes away after resting.
- Inflammation around the hip may cause painful muscle spasms.
In cases of physical activity, your child may not see the doctor until weeks or even months after experiencing symptoms.
Diagnosis of Legg Calve Perthes
An orthopedic specialist will examine a child’s legs to see if they rotate improperly. If the affected limb is inactive for a long time, the muscles in the thighs, calves, and buttocks can atrophy or shrink. It is also possible that the specialist will notice that the affected leg is shorter than the normal leg in cases of long-term Perthes disease.
Your child’s doctor will order an X-ray for your child if they are symptomatic of Perthes disease. You can often confirm the diagnosis with an X-ray. If necessary, your provider may order further tests, such as an MRI, to see how far your disease has progressed.
Additionally, your healthcare provider may use other tests to check on the progress of the disease. In some cases, your child’s thigh is measured to determine whether there is muscle atrophy (loss of muscle tissue). Additionally, your child’s doctor may ask them to perform some activities to see how much range of motion they have.
Treatment of Legg Calve Perthes
Treatment aims to relieve pain, protect the femoral head, and restore normal hip movement. These deformities can contribute to hip problems such as arthritis in adults, as femoral heads do not fit well within the acetabulum if left untreated.
It is possible to treat Perthes disease in some ways. Several factors will go into the development of the treatment plan for your child, including:
- Child’s Age: A child’s bones develop more rapidly when they are young (age six and under).
- Damage to the Femoral Head: A femoral head with more than 50% necrosis has a lower chance of regrowing without deformity.
- Diagnosis Stage of the Child: Depending on where your child is in the disease process, your doctor may recommend various treatment options.
Movement is essential to maintaining a healthy joint. To maintain the cartilage on the femoral head, the joint fluid, known as synovial fluid, is needed for nutrition. It helps to supply cartilage with this fluid when you move your hip.
Maintain as much time as possible in the hip socket after surgery so that the bone re-forms into the most round and healthy shape possible. Some children may need help keeping the ball in the cup if their hips are stiff. If necessary, your doctor may prescribe casts, braces, and physical therapy during this time.
In children younger than 6, surgery is not commonly recommended for Legg-Calve-Perthes disease. An important goal of surgery is containment. In other words, the femoral head must remain in the acetabulum.
During such surgery, the pediatric orthopedic surgeon may adjust the ficus and acetabulum’s angle to be positioned more anatomically correct. In an osteotomy procedure, the femoral head can grow naturally into a sphere.
When a child has Legg-Calve-Perthes disease in childhood, they are more likely to develop hip arthritis in adulthood – especially if the hip joint heals abnormally. When the hipbones don’t fit together properly after healing, the joint can wear out earlier.
Most children who get Legg-Calve-Perthes after six are more prone to hip problems later in life. When diagnosed, a young child has a better chance of having a healthy hip joint round and normal appearance.
For most children with Perthes, the prognosis is good, and they can reach adulthood without further hip problems.
There is a higher possibility of future problems with a femoral head that continues to have a deformity. However, if the femoral head still fits smoothly into the acetabulum, you may not experience problems. In cases where the deformed head cannot fit snugly in the acetabulum, hip pain or early onset of arthritis is likely to develop in adulthood.