Legg-Calve-Perthes disease treatment
Legg-Calve-Perthes disease, an uncommon disease that affects the bones in the hip and upper femur (thighbone), affects approximately one out of every 1,200 children each year. The right treatment and surgery for Legg-Calve-Perthes disease depends on a number of factors, such as the extent of the disease, your child’s age, present health, health history and history with various other medications and treatments.
Legg-Calve-Perthes disease can have significant effects on a child’s quality of life and ability to walk. Early detection is important, making it vital to seek medical attention as soon as you notice your child limping or experiencing pain in one hip. To diagnose the disease, the doctor will begin by reviewing your child’s medical history and asking some questions to get more information, then perform one or more of the following tests:
- Range of motion tests – The doctor may use a variety of physical tests to determine the range of motion in your child’s hip. If one hip has a better range of motion than the other, it will be clear that something is wrong on one side.
- X-ray (radiograph) – This is usually the first test done, as it allows the doctor to compare both sides of the hips. Because most people affected by this disease experience it only on one side, an X-ray can show significant differences between the hips. Using radiation, an X-ray shows the bone mass in the targeted area.
- Magnetic resonance imaging (MRI) – When patients or doctors prefer not to use radiation, MRIs are another imaging test that can provide the doctor with the necessary information to diagnose the patient. Your child will be put into a vessel containing a magnetic field. Then, radio waves are aimed at the child’s pelvis and femur, causing them to vibrate. A computer takes this resonance and turns it into a high-definition image.
- Arthrograms – This is a test done using diagnostics to study the non-bony aspects of the joint. Because this disease is a stoppage in the blood, studying these images is thought to give more insight into the blood flow through the joint.
If the extent of the Legg-Calve-Perthes disease is not severe, there may be nonsurgical treatments that a child can undergo to overcome the symptoms. First, your child may be put on crutches to reduce the pain felt when placing weight on the leg. Then, range of motion exercises may be performed to help get the leg moving properly again. Finally, casts, traction or braces may be used to repair any breakages and make the joint healthy again.
If nonsurgical treatment options have not been successful, the doctor may determine it is necessary for your child to have surgery to repair the joint. In this case, there are two common types of surgery:
- Tenotomy – When a muscle becomes atrophied, it is shortened and unable to grow to its natural length at the same pace as the rest of your child’s body grows. When this happens, tenotomy surgery is performed to release the atrophied muscle. The child is then put into a cast to allow the muscle to grow as normal and return to the size it was intended to be.
- Femoral varus osteotomy – This procedure is done on children whose disease has developed to the point where the bone has softened. When this occurs, the bone is far more likely to fall out of the socket. In this type of osteotomy surgery, the femoral head (the ball) is partially redirected back into the socket, with or without rotation.
- Osteotomy above the hip bone – When surgery is approached from the top, the femoral head has less opportunity to become deformed during the procedure. In this case, added coverage is given to the ball from the top lip of the socket to better protect it against deformation.
Much of the research into Legg-Calve-Perthes disease surrounds the early diagnosis of this rare occurrence in children. To achieve earlier diagnosis, it is important for doctors to know the cause of the disease, which is currently unclear.
Legg-Calve-Perthes disease affects boys 80 percent more often than it does girls. These boys are usually smaller in stature and are involved in sports and other high-energy activities. It most often affects the firstborn child. This knowledge has given some researchers insight into the cause, which is believed to be related to genetics, but there is still too little information to determine this definitively.
Because the prognosis and overall recovery of a child with Legg-Calve-Perthes disease depends on early detection, more focus has been placed on how to find this rare degenerative illness quickly. New tests are being put through trials to help get a better glimpse into the blood flow through the joint area, as well as to better understand what causes the femoral head to start degenerating. The later this disease is caught, the more difficult it is to treat and the more likely the child is to have long-term effects from the degeneration.
As research on various detection methods and causes is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of hip and leg experts at Northwell Health Orthopaedic Institute performs Legg-Calve-Perthes disease surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.