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 femur head and neck is hampered. Because of interrupted blood supply, rounded shape of femoral head is disturbed. It may affect one or both hip. Usual age of presentation is 4-12 year 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 vessel of femoral blood due to blood clotting disorder, blood cell morphology like sickle cell anemia or decrease in blood supply to femoral head. But most of time, causes are not known.
Symptoms of Perthes Disease: Initially painless limping is the presentation. With further damage in ball of hip joint, child will start having pain. Shortening of limb & radiating pain to knee can also be present. Slowly the movement of hip joint gets reduced. Restriction of hip joint rotation and other movement will also present..
Tests for Perthes Disease: Initial test is the physical exam of child by pediatric orthopedic surgeon. Then he will advice for X-Ray of hip AP & Lateral view. Mri & Ct scan are needed to evaluate the shape of femoral head and associated synovitis and to rule out other problem.
How Perthes Disease diagnosed in a child? Perthes disease is being diagnosed by history of limping, painful restriction of hip movement, x-ray & MRI showing ischaemic insult in femoral head. Diagnosis will need consultation from pediatric orthopedic surgeon.
Non Surgical Treatment of Perthes Disease: Medicine is required to treat pain and swelling in hip joint. Rest and exercise is required to improve the movement of joint. Some time plaster and brace is required to maintain hip in situ. If child started having pain and slight restriction of hip joint movement then we do small cut in adductor area and apply plaster in anesthesia with leg wide apart. With this plaster, child can have supported walking. This plaster has to be kept for few months. Abduction brace are useful bur very cumbersome for most of the 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 year may need different kind of pediatric orthopedic surgery. Surgery is required to place the ball of femur in socket of hip joint. Type and indication of surgery is based upon percentage of roundness of femoral head & extrusion of part of head. In surgery some time need cutting the bone of femur or pelvis to place the ball in joint and fixation with 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 in younger age do very well and became nearly normal in due course of time. But affection in older age > 8 year require attention because in this age chances of deformation of ball is more, that can lead to arthritis in old age. But if round surface of head can be maintained by surgery then outcome can be much better.
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Dr. Jitendra Kumar Jain
Trishla Orthopedic Clinic & Rehab center, 182C / 350A, Tagore Town, Prayagraj (Allahabad) U.P-211002, India