Legg-Calve-Perthes disease, often called Perthes disease, is an uncommon condition in children affecting the hip. Perthes disease occurs when blood flow to the ball (femoral head) at the top of the thigh bone (femur) temporarily stops. If the growing bone does not get enough blood, it dies and the ball collapses and becomes flat. As a result, the ball no longer moves easily in the hip socket. The hip can become painful and stiff. Over a period of time, the blood supply comes back and new bone cells gradually replace the dead bone. This process may take up to 2-3 years. The disease can occasionally occur in both hips (5%-10%), but usually not at the same time.
This is an idiopathic disease, which means there is no known cause.
A number of factors have been discussed including: heredity, trauma, endocrine, inflammatory, nutritional, and altered circulatory aspects.
Risk factors may include: impaired and disproportionate growth, low birth weight, delayed skeletal maturity, short stature, systemic hormonal changes and low economic index.
This is 4-5 times more likely to occur in males than females.
This develops when children are between the ages of 4-10, but has been noted in children as young as 2 and as old as 16 year of age. The median age is 6-7.
Children with Perthes often have delayed bone age.
Caucasian children are at a higher risk.
Pain or stiffness in the hip, groin, thigh or knee. The pain may go away with rest.
Usually no history of prior trauma.
Decreased hip movement (range of motion).
Muscle loss/weakness in the thigh and hip area.
One leg may appear shorter than the other.
A thorough history and physical exam is the first step.
X-rays: general x-rays looking at the pelvis and hip joint are performed.
MRI: Magnetic Resonance imaging uses a different method to gather detailed data related to many parts of the body including organs, bones and many tissues.
Medications: We may use non-steroidal anti-inflammatories (NSAIDS) such as Ibuprofen (advil, nuprin, motrin) or Naprosyn (aleve) or Acetaminophen (Tylenol).
Non-surgical: Bed rest, physical therapy (including stretching exercises), various casts (petrie), braces and crutches have been used.
Surgical: Various procedures that the Nationwide Children’s Hospital Orthopedist will explain as needed.
The main focus in treating Legg-Calve-Perthes disease is to maintain as much bone in the femoral head and keep it as round as possible. The younger the child and the least amount of bone damage provide the child with the best outcome in keeping a healthy hip joint and avoiding pain, stiffness and arthritis. It is important for children and parents to follow the instructions regarding activities and exercise provided by the specialists.
In more severe cases, some children require surgery to improve the hip joint movement and help reduce pain. If your child should require surgery, the doctor will discuss the type of surgery, recovery time, and expected results from the surgery.
If your pediatrician or family practitioner feels a child may have Perthes, they may refer you to one of our hip specialists. Our hip clinic is here to help patients with this and other documented hip diagnoses. If the child is having continued pain, limping and stiffness, call (614) 722-5175 to request an appointment.
Websites: See these for information and success stories of people with Perthes.
We are participating member of the International Perthes Study Group (IPSG).