Legg-Calvé-Perthes syndrome (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Legg-Calve-Perthes disease is when the ball of the thighbone in the hip doesn't get enough blood, causing the bone to die.

What are the symptoms of Legg-Calvé-Perthes syndrome?
The first symptom is often limping, which is usually painless. Sometimes there may be mild pain that comes and goes.

Other symptoms may include:
 * Hip stiffness that restricts movement in the hip
 * Knee pain
 * Limited range of motion
 * Persistent thigh or groin pain
 * Shortening of the leg, or legs of unequal length
 * Wasting of muscles in the upper thigh

What causes Legg-Calvé-Perthes syndrome?
There are many theories about the cause of this disease, but little is actually known.

Without enough blood to the area, the bone dies. The ball of the hip will collapse and become flat. Usually only one hip is affected, although it can occur on both sides.

The blood supply returns over several months, bringing in new bone cells. The new cells gradually replace the dead bone over 2 - 3 years.

Who is at highest risk?
Legg-Calve-Perthes disease usually occurs in boys 4 - 10 years old.

When to seek urgent medical care?
Call for an appointment with your health care provider if a child develops any symptoms of this disorder.

Diagnosis
During a physical examination, the health care provider will look for a loss in hip motion and a typical limp. A hip x-ray or pelvis x-ray may show signs of Legg-Calve-Perthes disease. An MRI scan may be needed.

Treatment options
The goal of treatment is to keep the ball of the thighbone inside the socket. Your health care provider may call this "containment." The key to doing this is to make sure the hip has good range of motion. In some cases, bracing is used to help with containment.

Physical therapy and anti-inflammatory medicine (such as ibuprofen) can relieve stiffness in the hip joint. When the hip is painful, or the limp gets worse, restricting activities such as running may help reduce the inflammation. Nighttime traction may also help.

Health care providers no longer recommend several months of bedrest.

When these steps fail, surgery may be needed. Surgery ranges from simple lengthening of a groin muscle to major hip surgery to reshape the pelvis. The type of surgery depends on the severity of the problem and the shape of the ball of the hip joint.

It is important to have regular follow-up with your doctor and an orthopaedic specialist.

Where to find medical care for Legg-Calvé-Perthes syndrome?
Directions to Hospitals Treating Legg-Calvé-Perthes syndrome

What to expect (Outlook/Prognosis)?
The outlook depends on the child's age and the severity of the disease. In general, the younger the child is when the disease starts, the better the outcome.

Children younger than 6 years old who receive treatment are more likely to end up with a normal hip joint. Children older than age 6 are more likely to end up with a deformed hip joint, despite treatment, and may later develop arthritis.

Possible complications
Osteoarthritis may develop later in life. Early recognition and proper treatment of Legg-Calve-Perthes disease may minimize this complication

Prevention
Currently as the cause is not known, thus there is no prevention of this condition.