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    Legg-Calve-Perthes disease

    Coxa plana; Perthes disease

    Legg-Calve-Perthes diseaseoccurs when the ball of the thighbone in the hip does notget enough blood, causing the bone to die.

    Causes

    Legg-Calve-Perthes disease usually occurs in boys 4through 10 years old. There are many theories about the cause of this disease, but little is actually known.

    Without enough blood to the area, the bone dies. The ball of the hip collapses and becomes flat. Usually only one hip is affected, although it can occur on both sides.

    The blood supply returns over several months, bringing in new bone cells. The new cells gradually replace the dead bone over 2to 3 years.

    Symptoms

    The first symptom is often limping, which is usually painless. Sometimes there may be mild pain that comes and goes.

    Other symptoms may include:

    • Hip stiffness thatlimits hipmovement
    • Knee pain
    • Limited range of motion
    • Thigh or groin pain that does not go away
    • Shortening of the leg, or legs of unequal length
    • Muscle lossin the upper thigh

    Exams and Tests

    During a physical examination, the health care provider will look for a loss in hip motion and a typical limp. A hip x-ray or pelvis x-ray may show signs of Legg-Calve-Perthes disease. An MRI scan may be needed.

    Treatment

    The goal of treatment is to keep the ball of the thigh bone inside the socket. The health care provider may call this containment. The reason for doing this is to make sure the hip continues to have good range of motion.

    The treatment plan may involve:

    • A short period of bed rest to help with severe pain
    • Limiting the amount of weight placed on the leg by restricting activities such as running
    • Physical therapy to help keep the leg and hip muscles strong
    • Taking anti-inflammatory medicine, such as ibuprofen, to relieve stiffness in the hip joint
    • Wearing a cast of brace to help with containment
    • Using crutches or a walker

    Surgery may be needed if other treatments do not work. Surgery ranges from lengthening a groin muscle to major hip surgery, called an osteotomy, to reshape the pelvis. The exact type of surgery depends on the severity of the problem and the shape of the ball of the hip joint.

    It is important for the child to have regular follow-up with the doctor and an orthopaedic specialist.

    Outlook (Prognosis)

    Outlook depends on the child's age and the severity of the disease.

    Children younger than 6 years old who receive treatment are more likely to end up with a normal hip joint. Children older than age 6 are more likely to end up with a deformed hip joint, despite treatment, and may later develop arthritis.

    When to Contact a Medical Professional

    Call for an appointment with your health care provider if a child develops any symptoms of this disorder.

    References

    Canale ST. Osteochondrosis or epiphysitis and other miscellaneous affections. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Philadelphia, Pa: Elsevier Mosby; 2012:chap 32.

    Sankar WN, Horn BD, Wells L, Dormans JP. Legg-Calve-Perthes disease. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 670.3.

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    • Blood supply to bone

      illustration

      • Blood supply to bone

        illustration

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            Tests for Legg-Calve-Perthes disease

              Review Date: 8/22/2013

              Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

              The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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