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Legg-Calvé-Perthes disease is a condition of the hip in which the blood supply to the top of the thigh bone (femoral head) is temporarily disrupted. This causes pain and inflammation in the hip joint, as well as changes to the bone structure. When the blood supply is disrupted, the head of the femur is weakened and changes shape. This bone weakening causes the head of the femur to collapse and no longer move smoothly in the hip socket.
Although there are several stages in this condition, the blood supply will eventually return and your child’s bone will heal. When the bone heals, the shape of the head of the femur is no longer normal. The shape of the bone after it heals will determine how the hip joint will be affected later in life.
Unfortunately, there is no known cause for this disease. We do know that the decrease in blood flow to the ball shaped end of the thigh bone (femoral head) is generally what leads to hip injury in Perthes patients. However, it remains unknown why the blood flow to the femoral head becomes affected.
Perthes disease is relatively uncommon and there is ongoing research at medical centers around the United States that are working toward identifying a cause. The International Perthes Study Group is one organization formed by several international pediatric hip specialists around the world who are working together trying to advance the knowledge about Perthes disease. Our providers at the Child and Young Adult Hip program are proud to be part of the International Perthes Study Group.
Children between the ages of 2 and 12 are most commonly affected. Boys are more often affected than girls. The recovery can vary from patient to patient, but is often better when a diagnosis is reached in younger patients.
Perthes disease information from the American Academy of Orthopedic Surgeons
The diagnosis of Legg-Calvé-Perthes disease (also known as Perthes disease) is based on a detailed history, physical examination and confirmed by imaging. An x-ray will show the change in the bone structure of the head of the femur. In certain cases your doctor may choose to have a CT scan of your child’s hip. An MRI is often performed to give the doctor more information about the bone and the extent of the disease process.
At the Hip Program at Children’s Colorado, our orthopedic providers work specifically with pediatric hip conditions. We use x-rays, CT scans and MRI to determine a diagnosis.
Our providers are also part of an International Perthes Study Group, with the goal of improved understanding and treatment. Our hospital uses a special MRI technique called Perfusion MRI, which provides your child's doctor with a more accurate measurement of the amount of bone that is affected by Perthes disease. This allows a diagnosis to be made earlier in the disease process and also allows doctors to see implications of how the disease will progress.
X-rays are taken during your visit with the provider, and CT and MRI scans are performed in the radiology department. The CT scans take approximately 15 minutes to complete.
The MRI in patients over 6 years old is typically not a sedated procedure and lasts approximately 45 minutes to one hour. The MRI requires IV placement of contrast before the scan is done. Feel free to bring a movie or music for your child, and have him or her wear comfy clothes to the appointment.
Our providers are able to diagnosis your child’s condition based on patient history and age, the results of the physical examination (including pain and/or limitation of motion), and the results of the ordered imaging studies (such as an x-ray or the MRI).
Non-Surgical: Non-surgical measures are taken to help with pain and maintain good range of motion in the hip. Anti-inflammatory medication (like Ibuprofen or Naproxen) may be prescribed to help reduce inflammation in the hip and decrease pain. Because of pain and changes to the structure of the head of the femur, children can lose the ability to pull their leg to the side. Casting and/or bracing may be used to preserve the range of motion on the hip and help the head of the femur maintain a round shape.
Surgical: In some cases, a surgical intervention may be needed. A procedure called a femoral osteotomy will change the way the ball (femoral head) sits inside the hip socket (acetabulum). An incision is made in the thigh and the femur bone is cut and rotated for better alignment of the femoral head (ball) in the acetabulum (socket). The bone is secured with a metal plate and screws. This surgery is performed to help maintain the femoral head (ball) inside the acetabulum (socket).
Later in life, once your child’s healing process is complete, a surgical intervention may be necessary if there is femoro-acetabular impingement, which may develop as a result of the change in shape of the end of the thigh bone and the hip socket. Sometimes a surgical intervention is performed on the side of the pelvis to improve the deformity of the hip.
By working together as a team, we are able to develop a comprehensive approach to both patient diagnosis and individualized treatment plans. Specialists from our Hip Program offer a broad spectrum of options for our patients and extend to include experts in the fields of rehabilitation, physical therapy, rheumatology, anesthesiology and pain.
With a sole focus on hip disease in young patients, our Hip Program is nationally recognized for excellence in hip surgeries, and our doctors educate healthcare providers around the nation on hip diseases and surgery. Our goal is to provide our patients with options for pain control, function improvement, and preservation of the hip joint. We are very proud of being active leaders in the International Perthes Study Group.
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