Legg-Calve-Perthes disease (LCPD) is a rare hip disease that affects children. It is a pattern of bone tissue death and repair at the hip which can cause abnormal growth and development in children.
The hip is made of the ball-shaped head of the thigh bone (femoral head) and bowl-shaped socket of the pelvis. LCPD affects the femoral head. There are 4 stages of LCPD: Initial—Poor blood flow to the femoral head causes death of bone tissue. Inflammation can cause limping at this stage, which can last several months.Fragmentation—The dead bone tissue is removed and replaced by the body. At first the replacement bone is softer and weaker than normal bone and can be altered by normal pressures like walking. The shape of the femoral head changes during this time and the softer bone has an increased risk of a fracture. This stage can last up to 2 years.Reossification—The longest phase, often lasting a few years. The newly-shaped femoral head grows stronger.Healed—The regrowth of bone is done, and the femoral head shape is now permanent.
Severity of LCPD depends on the child's age when the disease started and how much damage was done during fragmentation.
Normal Hip Anatomy
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LCPD is caused by an interruption of blood flow to the femoral head. Low or blocked blood flow causes bone tissue death and begins the LCPD cycle. The exact cause of the interruption is not known. Known factors that may lead to loss of blood flow include: Changes in the blood supply, which can result in fewer blood vessels or inability of the blood vessels to deliver blood normallyProblems with blood clots or pooling that may cause pressure or compression inside bone tissueRepetitive stressGenetics
LCPD is more common in male and at ages 4-8 years. It is also more common in children with European, Asian, or Eskimo ancestry. Other factors that may increase your child’s chance of developing LCPD include: Small or short for ageDelayed maturityAthletic, active childSecondhand smoke exposureBlood clotting abnormalities
The primary symptom of LCPD is a limp when walking or running. Other symptoms may include: Hip painGroin, thigh, or knee painReduced range of motion in the hipShortening of the leg, or legs that are not the same lengthMuscle weakness in the upper thigh
You will be asked about your child’s symptoms and medical history. A physical exam will be done. During the exam, your child’s hip will be examined to see how far it can move. The doctor may refer your child to a specialist. An orthopedist focuses on bones and joints.
Images may need to be taken of your child's bones. This can be done with: X-rayMRI scanBone scans
Talk with your doctor about the best plan for you. Options include the following:
If your child’s symptoms are mild, your doctor may prescribe physical therapy. A therapist will work with your child to maintain range of motion. You may be taught certain exercises to do with your child at home.
Medical treatment is used to improve healing and prevent further injury to the hip. It may include using
crutches, traction, a brace, or cast.It
is usually done before surgery is recommended for children less than 6 years old.
In some cases, your child may need surgery. The top of the thigh bone may be resurfaced with metal. Bone removal may be done to reposition or reshape the hip bone.Rarely, the hip will be replaced.
There are no current guidelines to prevent LCPD because the cause is unknown.
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http://www.nonf.org/perthesbrochure/perthes-brochure.htm. Accessed February 11, 2016.
Leet AI, Skaggs DL. Evaluation of the acutely limping child. Am Fam Physician. 2000;61(4):1011-1018.
Perthes disease. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00070. Updated May 2015. Accessed January 17, 2017.
Last reviewed February 2016 by Warren A. Bodine, DO, CAQSM
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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