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Children’s Healthcare Of Atlanta

ITi - Perthes

 


 

Legg-Calve-Perthes Disease

What is Legg-Calve-Perthes Disease?


Legg-Calve-Perthes disease is a temporary condition in children in which the ball-shaped head of the thigh bone, referred to as the femoral head, loses its blood supply. As a result, the femoral head collapses. (The image to the left represents this.) The body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the femoral head of the thigh bone. Legg-Calve-Perthes disease causes the hip joint to become painful and stiff for a period of time.
Legg-Calve-Perthes disease goes through four phases of changes that affect the head of the femur. The phases include:

  • Phase 1--Blood supply is absent to 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 in appearance on X-rays. 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 Legg-Calve-Perthes Disease?


The cause of Legg-Calve-Perthes disease is unknown. It is four times more likely to occur in boys than girls.
Legg-Calve-Perthes disease commonly affects first-born children and is typically seen in children 4 to 8 years of age. The majority of cases affect only one hip.

Learn more about Legg-Calve-Perthes Disease.

Symptoms and Treatments


What are the symptoms of Legg-Calve-Perthes Disease?


The child typically complains of hip pain that is aggravated by activity. Sometimes, they will also experience pain in their thigh or knee area. The child usually walks with a limp and reports that rest will alleviate the pain. The symptoms of Legg-Calve-Perthes disease may resemble other conditions or medical problems of the hip. Always consult your child's doctor for a diagnosis.

How is Legg-Calve-Perthes Disease diagnosed?


In addition to a complete medical history and physical examination, diagnostic procedures for Legg-Calve-Perthes disease may include:

  • X-rays--A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.
  • Bone scans--A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
  • Magnetic resonance imaging (MRI)--A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.
  • Arthrograms--A diagnostic imaging test to study the non-bony structures of joints.
  • Blood tests

Treatment for Legg-Calve-Perthes Disease


Your child's physician will determine the specific treatment for Legg-Calve-Perthes disease based on:

  • Your child's age, overall health and medical history
  • The extent of the condition
  • Your child's tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • 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. Treatment options are dependent upon the amount of hip pain, stiffness and X-ray changes over time, as well as how much of the femoral head has collapsed.

Typically, the first step of treatment is to regain hip motion and eliminate pain that results from the tight muscles around the hip and the inflammation inside the joint. Treatment may include:

  • Rest
  • Activity restrictions
  • Medications
  • Bed rest and traction
  • Casting or bracing (to hold the femoral head in the hip socket, permit limited joint movement and allow the femur to remold itself into a round shape again)
  • 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 (in some cases)

2 related images

Perthes ap pelvis Perthes frog pelvis

What are X-rays?


X-rays are made by using low levels of external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a negative-type picture is made. The more solid a structure is, the whiter it appears on the film. For this reason, bones appear very white on an X-ray film, but less dense tissue such as muscle, blood, skin and fat appears darker. An X-ray provides a picture of inside the body by using special radioactive rays. An X-ray can show bones, tissues or parts of organs.

Eli Clarkson

Eli Clarkson is the kind of 8-year-old that feels the need to hurdle over a sofa to go from the living room to the kitchen. An hour playing outside usually comes with a new collection of grass stains, scrapes and bruises.

So when a limp and hip pain in his right leg slowed him down in the summer of 2011, his parents, Eric and Lynn, thought it was probably just a minor injury from being such an active kid.

“He was developing a really bad limp, and he was getting ready to play his first season of football in the fall,” Eric said. “He said his groin was hurting, and I just thought he pulled his groin.”

Perthes Diagnosis

An X-ray at Children’s Healthcare of Atlanta’s Scottish Rite hospital revealed that Eli had Legg-Calvé-Perthes disease, a condition that affects the top of the thigh bone. In a child with Perthes, the top of the thigh bone, or femoral head, loses blood supply and collapses.

Eric and Lynn were initially told that recovery in some cases of Perthes could take between three and five years and result in some long-term disabilities. The family’s pediatrician recommended they take Eli, 7 at the time, to see Tim Schrader, M.D., the Medical Director of the Children’s Hip Program.

“Dr. Schrader is a rockstar,” Eric said. “He told us he was doing a different procedure (for Perthes patients).”

Treating His Condition

One treatment for Perthes is core decompression, a minimally invasive procedure in which a hole is drilled into the femoral head to promote blood flow. Dr. Schrader uses core decompression but includes an additional procedure called bone marrow aspirate concentrate (BMAC). During this procedure, a sample of bone marrow is taken out the hip bone and placed into the femoral head. This extra step can help the recovery process by increasing blood flow and helping the bone grow stronger.

Eli had the procedure Aug. 25, 2011. He had to stay in a cast and wheelchair for about six weeks. He wore a brace for another four months.

“We had a reserved optimism,” Eric said. “We didn’t really have anything to gauge it against. We listened to and believed in Dr. Schrader. We had hope.”

Recovery and Physical Therapy

Eli Clarkson in Physical TherapyEli attended physical therapy with Andrea Carmin, P.T., twice a week for six months at Children’s at Meridian Mark. He quickly developed a bond with Andrea and worked hard to build strength and flexibility in his hip.

The Clarkson family had regular follow-up appointments with Dr. Schrader, during which they would see before and after X-rays of their son’s hip. For the most part, they could never tell a difference.

But when they had their most recent appointment, six months since their previous one, they saw a big difference.

“There was this beautiful, white ball that is his femoral head,” Eric said. “My wife and I just looked at each other and said, ‘There it is. That is what has been missing.’”

Eli has returned to two of his favorite sports—swimming and baseball—and will play football in the fall.

“He had the most phenomenal attitude through the whole thing,” Eric said. “I never thought a 7-year-old boy could be my hero.”