Legg-Calvé-Perthes Disease

What is Legg-Calvé-Perthes disease?

Legg-Calvé-Perthes disease, or Perthes disease, is a childhood hip condition in which the ball-shaped head of the thigh bone (femoral head) loses its blood supply and collapses. The body will absorb the dead bone cells and replace them with new bone cells. The new bone cells eventually reshape the femoral head of the thigh bone.

Legg-Calvé-Perthes disease causes the hip joint to become painful and stiff. It can also leave the femoral head deformed and lead to disability.

Perthes disease goes through four phases:

  • Phase 1: Blood stops reaching the femoral head, and the hip joint becomes inflamed, stiff and painful. Portions of the bone turn into dead tissue. The ball of the thigh bone becomes less round. This phase can last from several months up to one year.
  • Phase 2: The body cleans up the dead bone cells and replaces them with new, healthier bone cells. The femoral head begins to remodel into a round shape again. The joint is still irritated and painful. This phase can last from one to three years.
  • Phase 3: The femoral head continues to model itself back into a round shape with new bone. This phase lasts for one to three years.
  • Phase 4: Normal bone cells replace the new bone cells. This last phase can last a few years to complete the healing process.

What causes Perthes disease?

The cause of Perthes disease is unknown. It is four times more likely in boys than girls, and commonly affects firstborn children. It usually affects children 4 to 8 years of age. Most cases affect only one hip.

How to spot Perthes disease

The most common signs include:

  • Walking with a limp
  • Limited range of motion in the hip
  • Pain in the hip, thigh or knee area made worse by activity

The symptoms may resemble other conditions or medical problems of the hips, so it’s important to talk to your child’s doctor.

How we diagnose Perthes disease

Our team uses a thorough set of assessments to diagnose Perthes disease:

  • A complete medical history and physical examination
  • X-ray
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Arthrograms
  • Blood tests
  • Bone scans

How we treat Perthes disease

Our team will work with you to create a treatment plan for Perthes disease based on:

  • Your child's age, overall health and medical history
  • Amount of hip pain or stiffness
  • Degree of femoral head collapse
  • Progression of the condition
  • Your child's tolerance for certain medications, procedures or therapies
  • How the condition is likely to affect your child
  • Your opinion or preference

The goal of treatment is to preserve the roundness of the femoral head and to prevent deformity while the condition runs its course. At first, treatment focuses on regaining hip motion and reducing pain from the tight muscles around the hip and inflammation inside the joint.

Treatment may include:

  • Rest
  • Reduced activity
  • Medications
  • Bed rest and traction
  • Casting or bracing (to hold the femoral head in the hip socket, restrict joint movement and allow the femur to remold itself into a round shape again)
  • Arthroscopic or open surgery (to hold the femoral head in the hip socket)
  • Physical therapy (to keep the hip muscles strong and to promote hip movement)
  • Crutches or wheelchair

Femoroacetabular Impingement (FAI)

What is femoroacetabular impingement (FAI)?

FAI is too much friction between the top of the thigh bone (femoral head) and the outside part of the hip socket (acetabulum). This might damage the hip joint over time.

Some childhood problems can lead to FAI. These include:

  • Legg-Calve-Perthes disease
  • Slipped capital femoral epiphysis (SCFE)

Some doctors believe that heavy physical activities before the body stops growing may lead to FAI. Football and weightlifting are activities that might lead to FAI.

Two major types of FAI

Most people with FAI have both types, including:

  • Cam: This type happens when the top of the thigh bone (femur) has an odd shape. An abnormal bump on the upper femur can cause uneven contact with the hip socket, possibly damaging the cartilage.
  • Pincer: This type happens when the outside part of the hip socket is too deep or goes in the wrong direction. This might cause pinching of the outer part of the cartilage (labrum) with movement.

How to spot FAI

Signs of FAI can begin in the childhood, but it is much more common in young and middle-aged adults. The signs may get worse with age and include:

  • Pain in the hip, lower back, groin, thigh or knee
  • Pain during physical activity, such as walking or running
  • Pain after sitting for a long time
  • Loss of motion in the hip joint
  • Labral tears
  • Cartilage damage
  • Early hip arthritis
  • Hyperlaxity (too much movement in the hip)

How we diagnose FAI

Our team uses equipment designed to diagnose issues related to FAI in kids and teens:

  • A complete medical history and physical examination
  • X-ray
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT)

How we treat FAI

Treatment can include:

  • Medications
  • Physical therapy
  • Limiting physical activities
  • Arthroscopic or open surgery, depending on the amount of damage to the cartilage

Developmental Dysplasia of the Hip (DDH)

What is developmental dysplasia of the hip (DDH)?

Developmental dysplasia of the hip (DDH), also called hip dysplasia, can be present at birth or develop as your child grows. It describes a wide range of problems, such as a misshapen ball or socket, or a loose hip joint.

DDH occurs in one in every 1,000 births. It can run in families or can be caused by something in the baby’s environment. It is more common in girls, and more likely to occur in the left hip. There are several risk factors linked to DDH, including:

  • Family history of DDH
  • Very flexible ligaments
  • Position of the baby in the uterus, such as breech position
  • First-born babies (because the uterus is small)
  • Limited space in the uterus
  • Other orthopaedic problems that include metatarsus adductus, clubfoot deformity, congenital conditions and other syndromes

How to spot DDH

In babies, infants and toddlers with DDH:

  • One leg may appear shorter than the other
  • The rotation of one hip may be different
  • Folds in the skin of the thigh or buttocks may be uneven
  • Space between the legs may look wider than normal
  • The hip may shift, click or clunk during certain movements, such as diaper changes

Signs of DDH in adolescents, teens and young adults include:

  • Hip pain
  • Clicking sound in the hip joint
  • Catching feeling in the hip joint
  • Too much or too little movement of the hip
  • One leg shorter than the other

How we diagnose DDH

Our team takes a specialized approach to diagnosing DDH complications in children:

  • A complete medical history and physical examination (Your doctor will do a physical exam of your child at birth and during infancy to check for DDH and other hip problems. Signs may not show until later in life.)
  • X-ray
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scan
  • Ultrasound (used in children under six months of age)

How we treat DDH

The goal of treatment is to put the ball back into the hip socket so the hip can develop normally. Some hips do not continue to develop normally and need more treatment.

Treatment for your child is based on:

  • Your child’s age
  • The extent of the DDH
  • Your child’s medical history
  • Your child’s tolerance to medicine, procedures and therapies

Treatment options may include:

  • Pavlik harness: A tool for babies up to 6 months of age. This harness keeps the hip in the right place while allowing the legs to move, and is usually worn for at least six weeks. It’s important for a doctor to monitor the hips as your child grows. The hips may not fully develop, requiring further treatment.
  • Abduction brace: A hard, plastic brace with foam padding that holds the hips more firmly than a Pavlik harness. It’s normally worn for at least three months.
  • Surgery: Allows the doctor to manually put the hip into place. If the other methods are not successful, or if DDH is diagnosed after the age of 6 months, surgery and casting may be needed. After surgery, you child may have to wear by a special spica cast.
  • Periacetabular osteotomy (PAO): In this treatment for older children, cuts are made around the hip socket, allowing the hip socket to be moved into a more normal position. This reduces joint stress and improves hip movement. A PAO may also delay or prevent the need for a total hip replacement later in life.
  • Physical therapy: Used to make the muscles around the hip stronger and help teach children how to walk again.

Slipped Capital Femoral Epiphysis (SCFE)

What is slipped capital femoral epiphysis (SCFE)?

Slipped capital femoral epiphysis (SCFE) is the most common pathologic condition affecting the adolescent hip, which is more likely to occur in boys than girls. Children ages 11 to 15 are most at risk.

In SCFE, the head, or "ball," of the thigh bone (the femoral head) slips off the neck of the thigh bone. This condition causes the hip joint to become painful and stiff. An acute slip results from an accident or other trauma. A chronic slip happens over a period of time, from weeks to years.

SCFE is more common among African-Americans. About one half of cases affect both hips.

SCFE can range from mild to severe:

  • Mild: Up to one-third of the femoral head slips off of the thigh bone.
  • Moderate: About one-third to one-half of the femoral head slips off of the thigh bone.
  • Severe: More than one-half of the femoral head slips off of the thigh bone.

The cause of SCFE is unknown. Risk factors include:

  • Obesity
  • Medications (such as steroids)
  • Thyroid problems
  • Radiation treatment
  • Chemotherapy
  • Bone problems related to kidney disease

How to spot SCFE

The symptoms of SCFE may resemble other conditions or medical problems of the hip. Symptoms of SCFE typically include:

  • Pain in the hip that is aggravated by activity
  • Pain in the groin, thigh or knee area
  • Sudden pain, limp or feeling like the leg is giving way (acute slip)
  • Hip pain and limp that is relieved by rest (chronic slip)
  • Walking with leg turned outward
  • Feeling or hearing a click in the hip

How we diagnose SCFE

  • A complete medical history and physical examination
  • X-ray
  • Magnetic resonance imaging (MRI)

The goal is to diagnose the condition early, to prevent the head of the femur from slipping further off of the thigh bone.

How we treat SCFE

When SCFE is diagnosed, your child should stop standing, walking or bearing weight on the hip. Your child will need crutches or a wheelchair for a while.

We will work with you and your child to create a treatment plan based on:

  • Age, overall health and medical history
  • The extent of the condition
  • Your child’s tolerance for medications, procedures or therapies
  • How the condition is likely to affect your child
  • Your opinion or preference

Treatment may include:

  • Surgery: Involves the use of a steel pin to hold the femoral head onto the femur to prevent further slipping. This may be minimally invasive surgery, which involves a small incision and it done percutaneously.
  • Physical therapy: Used after surgery to help strengthen the hip and leg muscles.

Apophysitis

What is apophysitis?

Apophysitis is an overuse injury. Repeated movement and stress to the muscles attached to the bone can inflame and irritate the muscles. This can cause inflammation at the point where the tendon (soft tissue) attaches to the bone. The results can be pain, swelling and tenderness in the hip area.

The injury is common in children and teens, ages 12 to18, who have:

  • Growth spurts, when bone growth can put added stress on the muscle
  • Tight hips and thigh muscles
  • Training or competing in sports for long periods of time
  • Knock-knees and pronation (inward roll of the foot)

Young athletes are prone to apohpysitis, especially:

  • Dancers
  • Hockey players
  • Runners
  • Soccer players
  • Sprinters

How to spot apophysitis

Symptoms of apophysitis can include:

  • Dull pain in the groin or front side of the hip
  • Pain or discomfort that gets worse with continued activity
  • Tenderness and swelling at the site of the injury

Apophysitis is often mistaken for muscle strain.

How we diagnose apophysitis

We help make diagnosing this injury as simple as possible. Most cases are identified through:

  • A complete medical history and physical examination
  • X-ray

How we treat apophysitis

Our team will recommend a recovery plan tailored for your child’s needs.

Treatment may include:

  • Rest from the activity that is causing the pain and inflammation
  • Icing the injured area for 15 to 20 minutes during a three-hour span every day
  • Medication to reduce inflammation
  • Physical therapy to build strength and flexibility

Be careful about letting your child return to sports after the pain has subsided. If the child or teen can’t walk normally without a limp, he or she likely isn’t ready to return to sports. When the pain is gone, gentle stretching and strengthening of the area can begin. Returning to sports and other activity should be gradual.

The symptoms of apophysitis may come and go as your child gets older. They will stop when he or she stops growing.

Snapping Hip

What is snapping hip?

Children with snapping hip may feel or hear a click or pop when the hip moves. This may cause pain that can get worse with activity. Not all cases need treatment.

There are three types of snapping hip syndrome:

  • External snapping hip: Caused when a band of muscle catches on the outside of the hip bone when the hip is flexed. This is the most common type. It can be painless or painful.
  • Internal snapping hip: Happens when the muscles that flex the hip slide over the bony bump on the pelvic bone and cause snapping on the inner upper thigh. Most cases are not painful. Both external and internal snapping hip syndrome happen in teens or adults. Most painless clicks in babies and infants are normal but your doctor should help determine if the click is benign or a sign of hip dysplasia.
  • Intra-articular snapping: Occurs when a free-floating fragment of bone or cartilage gets caught between the joint. This type might require surgery.

How we diagnose snapping hip

If your child or teen has symptoms of snapping hip, it’s important to get the injury properly diagnosed. The process may include:

  • A complete medical history and physical examination
  • X-ray
  • Magnetic resonance imaging (MRI)
  • Ultrasound

How we treat snapping hip

Treatment for pain from this injury may include:

  • Rest from activities that increase or cause pain. Slowly return to sports and activity once pain is gone and flexibility and strength have improved.
  • Icing the injured area for 15 to 20 minutes during a three-hour span every day.
  • Medication to reduce inflammation.
  • Physical therapy to build strength and flexibility.
  • Surgery, usually arthroscopic (minimally invasive) if needed; a surgical procedure is rarely needed.