Legg-Calve-Perthes Disease Treatment

Introduction of Perthes Disease:

A Perthes disease is also known as Legg-calve-Perthes disease. It is a childhood condition that affects the hip joint. In this disease blood supply to the femur head and neck is hampered. Because of interrupted blood supply, the rounded shape of the femoral head is disturbed. It may affect one or both hips. The usual age of presentation is 4-12 years old. It developed in stages.

Causes of Perthes Disease:

Disturbance in blood supply is the common cause. It may be due to blood clots in blood vessels of femoral blood due to blood clotting disorder, blood cell morphology like sickle cell anemia, or a decrease in blood supply to the femoral head. But most of the time, causes are not known.

Symptoms of Perthes Disease:

Initially painless limping is the presentation. With further damage in the ball of the hip joint, the child will start having pain. Shortening of limb & radiating pain to the knee can also be present. Slowly the movement of the hip joint gets reduced. Restriction of hip joint rotation and another movement will also present.

Tests for Perthes Disease:

The initial test is the physical exam of a child by a pediatric orthopedic surgeon. Then he will advise for an X-Ray of hip AP & Lateral view. Mri & Ct scans are needed to evaluate the shape of the femoral head and associated synovitis and to rule out other problems.

How Perthes Disease diagnosed in a child?

Perthes disease is being diagnosed by the history of limping, painful restriction of hip movement, x-ray & MRI showing ischaemic insult in the femoral head. Diagnosis will need consultation from a pediatric orthopedic surgeon.

Non-Surgical Treatment of Perthes Disease:

Medicine is required to treat pain and swelling in the hip joint. Rest and exercise are required to improve the movement of the joint. Some time plaster and the brace are required to maintain the hip in situ. If a child started having pain and slight restriction of hip joint movement then we do a small cut in the adductor area and apply plaster in anesthesia with a leg wide apart. With this plaster, the child can have supported walking. This plaster has to be kept for a few months. An abduction brace is useful but very cumbersome for most children. It needed to be wear for months.

Surgical Treatment of Perthes Disease:

The goal of Perthes disease treatment is to reduce painful symptoms, protect the femoral head shape, and restore natural hip movement. In severe cases and children of older age, more than 8 years may need a different kind of pediatric orthopedic surgery. Surgery is required to place the ball of the femur in the socket of the hip joint. Type and indication of surgery are based upon a percentage of roundness of femoral head & extrusion of part of the head. In surgery some time need cutting the bone of the femur or pelvis to place the ball in the joint and fixation with a steel plate and screw. Therapy may be required afterward to improve hip joint movement. There are many Perthes disease treatment options. While developing a treatment plan for your child, your doctor will consider numerous factors.

Prognosis of Perthes Disease:

Most of the children at a younger age do very well and became nearly normal in due course of time. But affection in older age > 8 years require attention because in this age chances of deformation of the ball is more, that can lead to arthritis in old age. But if the round surface of the head can be maintained by surgery then the outcome can be much better.

Perthes Disease Treatment before Surgery
Perthes Disease Treatment After Surgery
Perthes Disease Treatment Image

Frequently Asked Questions

What are the stages of Perthes disease?

The stages are – 

  • Initial stage, 
  • Fragmentation stage, 
  • Healing period, 
  • Growing period, 
  • Definite stage
What happens if Perthes disease is left Un-Treated?

If Perthes Disease is not treated properly, then it can create complications in adulthood, such as early-onset arthritis.

What activities are safe or helpful for my child?

To know better about the activities that are safe and also helpful for your child, you should consult the doctor because it depends on the stage of the disease, symptoms, stiffness of the hip joint, and also the age of the child.

MEDICALLY REVIEWED AND EDITED BY DR. JITENDRA KUMAR JAIN
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Dr. Jitendra Kumar Jain is a famous name in the field of childhood physical disability pediatric orthopedic problems in North India. He has been an MS Orthopedics, DNB Orthopedics, Pediatric orthopedic surgeon & also a cerebral palsy specialist for over 21 years.

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