Legg-Calve-Perthes Disease

What is Legg-Calve-Perthes disease?

Legg-Calve·Perthes Disease, also known as Perthe’s Disease, is a self·limiting disease in which there is an interference to the blood supply to the head of the femur (hip bone), leading to the death of tissue (avascular necrosis), followed by regeneration and healing.

Causes and symptoms of Legg-Calve-Perthes disease

While its cause is idiopathic, there is a strong preponderance towards males (5:1) and can affect children at ages 4·12 with the most falling between the ages 4-8.

It may present EARLY as an insidious onset of a painful limp, with pain coming from the hip, thigh or knee, aggravated with exercise, and associated with decreased range of motion. As a consequence, the child’s gait Is altered.

It may also present LATE, in which there is a shortening of the limb/Limb Length Discrepancy, with a decrease in the range of movement as well as an altered walking pattern (Trendelenburg gait).

What are the risks in children who have Legg-Calve-Perthes disease?

Although it is a self-limiting disease, it is important to identify it early to prevent as much damage to the hip joint as possible. As the head undergoes avascular necrosis it becomes deformed.

If no intervention is performed, it persists in this fashion and starts to heal in the deformed fashion. A resultant irregular and deformed head will lead to joint deformity and predisposes to early Osteoarthritis of the Hip Joint.

Figure 1. legg CalveFigure 1. AP X-Ray (Left) &  Frog-Lateral View (Right) of the pelvis showing lesion on left hip.

Therefore, it is imperative that early diagnosis is made in order to prevent further progression so as to allow the hip joint to develop as normally as possible.

How is Legg-Calve-Perthes disease diagnosed?

X-rays are useful as a first·line investigation and can help us with the classification of the stage the disease is in, guide management and provide the prognosis.

Sometimes other radiological investigations such as Bone Scans and MRI may be required in the early stages to aid in diagnosis.

Laboratory investigations may also be performed if the distinction between this disease and infection is unclear. Other tests can also be performed to rule out certain metabolic and genetic
disorders.

How Legg-Calve-Perthes disease is treated?

As stated above, the aim Is damage control and to allow the hip joint to develop as normally as possible, by containing the femoral head within the hip joint to equalise the pressure as well as to allow moulding and obviate further deformities, to accommodate a good range of motion.

Therefore, depending on the stage of the disease as well as the age of the patient, the treatment may range from symptomatic relief to protected weight-bearing and bracing to surgery.

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