Pediatric Legg-Calvé-Perthes Disease

Legg-Calvé-Perthes disease (or Perthes disease) is a rare hip condition that affects children.

Over a number of years, the ball-shaped top of a child’s thighbone (femoral head) breaks down and re-forms.

The disease goes through four phases:

• Initial phase. The femoral head loses its blood supply. The hip joint becomes inflamed, stiff and painful. Parts of the bone turn into dead tissue. The ball of the thighbone becomes less round. This phase can last from several months up to one year.
• Fragmentation phase. The body absorbs the dead bone cells and replaces them with new, healthier bone cells. The femoral head begins to re-form into a round shape. The joint is still irritated and painful. This phase can last from one to three years.
• Reossification phase. The femoral head continues to re-form into a round shape with new bone. This phase lasts for one to three years.
• Healing phase. Normal bone cells replace the new bone cells. This last phase can last a few years to complete the healing process.

The cause of Legg-Calvé-Perthes disease is unknown. It is four times more likely to happen in boys than girls. It can be seen in children ages 2 to 12. The majority of cases affect only one hip.

Children with Legg-Calvé-Perthes disease have:

• Pain in their hip that gets worse with activity
• Pain in the thigh or knee area
• A limp
• Muscle loss in the upper leg and hip

These symptoms may seem like other health problems of the hip. Make sure your child sees their healthcare provider for a diagnosis.

Your child’s healthcare provider will do a complete health history and physical exam of your child. Your child may also need:

• X-rays. This test makes images of internal tissues, bones and organs.
• Bone scans. This test looks for any breakdown in the joints. It helps find bone diseases and tumors. It can find the cause of bone pain or inflammation.
• Magnetic resonance imaging (MRI). This test uses a combination of large magnets, radiofrequencies and a computer to make detailed images of organs and structures within the body.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

The goal of treatment is to keep the roundness of the femoral head and to prevent deformity while the condition runs its course. Treatment depends on the amount of hip pain and stiffness. It is also based on X-ray changes over time and how much the femoral head has collapsed.

The first step of treatment is usually to regain hip motion. It also tries to stop the pain that results from the tight muscles around the hip and the inflammation inside the joint. Treatment may include:

• Rest. Your child may need to limit activity. They may need crutches or a wheelchair. In some cases, your child may need bed rest.
• Medicines. Pain relievers such as ibuprofen may help ease pain in the hip joint.
• Casting or bracing. This treatment can hold the femoral head in the hip socket. It also lets your child move the joint a bit and allows the femur to remold itself into a round shape.
• Surgery. Your child may need surgery to hold the femoral head in the hip socket.
• Physical therapy. This treatment can keep the hip muscles strong and promote hip movement.

The more severe the case, the greater the likelihood that your child may have limited hip motion, differences in leg lengths and other hip problems in adulthood.