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Legg-Calve-Perthes disease is a problem with the ball-and-socket joint where the femur (thighbone) and pelvis meet. It happens when the joint temporarily does not get enough blood. This causes the bone to die, making it more likely to break. The ball part of the socket becomes flat and more difficult to move.
After several months, the blood supply returns to the joint. Over the next few years, the new blood cells slowly rebuild the dead bone. Legg-Calve-Perthes usually affects one hip, but it can affect both. One of the most common hip disorders, it is found in about 5 children per 100,000. The disease is most common in boys between the ages of 4 and 10.
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Patients can be seen by Texas Children's experts in Orthopedics.
Causes & Risk Factors
The cause of Legg-Calve-Perthes disease is not yet known.
Risk factors include:
- Age: Children of any age can have the disease, but it is most common between ages 4 and 10
- Gender: It is 5 times more common in boys
- Race: It is more common in white children of Northern European ancestry
- Family history: In rare cases, Legg-Calve-Perthes runs in families
Symptoms & Types
Limping is often the first symptom of Legg-Calve-Perthes disease. The condition usually is painless, but the child may feel slight discomfort that comes and goes.
Other signs may include:
- Knee pain
- Stiff hips, less movement in hips
- Pain in thigh or groin
- Difference in length of legs
- Loss of upper thigh muscles
- Limited range of motion
Diagnosis & Tests
To test for Legg-Calve-Perthes disease, the doctor first will complete a detailed medical history and physical exam. The doctor will examine the child for a limp or loss of hip motion.
Other tests may be done, including imaging tests, such as X-rays or MRI (magnetic resonance imaging).
Treatment & Care
Legg-Calve-Perthes disease is treated by keeping the thighbone as round as possible and inside the socket. This is called containment. It lets the bone heal and makes sure the hip keeps good range of motion.
Treatment may include:
- Bed rest
- Limiting certain activities, like running
- Physical therapy
- Anti-inflammatory medicine to help with pain and stiffness in the hip
- A cast or brace
- Use of walker or crutches
If these methods do not work, surgery may be needed. The type of surgery depends on how bad the problem is and the shape of the ball in the hip joint. It may range from a procedure to make a groin muscle longer to osteotomy, a major surgery to reshape the pelvis.
Living & Managing
While certain activities, such as running, are restricted during treatment for Legg-Calve-Perthes, it is often possible for a child to remain active. Swimming is often a good type of exercise.
Some children with Legg-Calve-Perthes disease have arthritis when they are adults.
How well a child does depends on his age and how advanced the condition is. If he is treated younger than 6, chances are high the hip joint will be normal. It is more common for children over 6 to have a deformed hip joint after treatment and have arthritis later in life.
Early diagnosis and regular follow-up visits with an orthopedic specialist are important.