Legg-Calve´ Perthes Disease



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An Orthopedic FAQ

Legg-Calvš-Perthes disease (LCPD) is a condition where the part of the of thighbone (femur) that meets the hip deteriorates because it does not get enough blood. It is most often diagnosed between the ages of 4 and 8 years of age, but may be noticed also before the child is two years old. The disease is also known as coxa plana, Legg-Perthes disease, or simply, Perthes disease.

The interruption of the blood flow occurs over a of one to three weeks. And causes the bone to die. Then revascularization - a return of the blood supply - occurs. Within two or three years, new bone replaces the old, dead bone.

During the period of revascularization, the bone is soft and it can break fairly easily when pressure is applied.

The condition is more common in boys than girls and most often only one leg is involved.

Causes of Legg-Calve´Perthes Disease

Some things that may be associated with the condition include:

Symptoms of Legg-Calvš-Perthes Disease

Symptoms of Legg-Calvš-Perthes disease include:

Often, the child is diagnosed with the condition only after the bone has fractured, which can happen when the blood supply returns to the bone.

Treatment of Legg-Calvš-Perthes Disease

Because the body regenerates new bone after time, LCPD often resolves itself with no treatment. For children with LCPD who are under age four, the prognosis is usually good, whether treatment is provided or not.

Sometimes though, without treatment, the child may develop later problems with degenerative arthritis in the hip.

If your child's doctor suspects LCPD, he or she will probably order x-rays of the hip area.

The aim of treatment is to protect the bone and joint from further stress and injury and improve the range of motion. If it is early in the disease, traction and physical therapy may be recommended to relieve the tightness.

Traction uses weights on a pulley system to help stretch the muscles and relax the thighbone with the idea of gently moving it back into its socket. the limb so that the muscles gradually stretch and relax allowing the

Once the bones are where they are supposed to be, a brace or cast may be used to keep the head of the femur where it belongs. The most common methods involve using the Petrie cast and the Scottish-Rite (Atlanta) brace. These are usually worn for a period of 18 to 24 months.

The Petrie cast runs from mid thigh to ankle. Two wooden bars are placed at the knee and ankle, forming an A-shape frame for the leg. This helps give the right amount of stretch to the thigh. The cast stays on for about two to three months and will be then be changed.

In some cases surgery called femoral osteotomy is done to redirect the bone. This involves cutting the thighbone just below the hip, and moving it to where it belongs. Often screws are used to hold it in place. There does not seem to be any advantage of surgery over the casting method.

After 18 months to two years of treatment, the majority of children return to normal activities without major limitations.