Legge-Calve-Perthes disease is inflammation of the femoral head, possibly due to loss of blood supply. The femoral head is the ball on the end of the thighbone that fits into the socket of the hip joint. This disease may eventually lead to destruction of the femoral head.
If the blood supply to the femoral head is lost for any reason, the bone cells die. This can cause the round femoral head to lose its shape. The bone changes may cause arthritis, or chronic joint inflammation. Ninety percent of the time, only one hip is affected.
Legge-Calve-Perthes disease usually causes pain in the thigh and groin. This usually results in limping. The pain may go down the front of the thigh to the knee. Movement of the hip may be restricted and painful, especially when the person spreads his or her legs apart.
The exact cause of Legge-Calve-Perthes disease is unknown. It is thought to be linked to disrupted blood supply to the bone. This disease typically occurs between the ages of 4 and 10. Boys are five times more likely to be affected than girls.
There is no known way to prevent Legge-Calve-Perthes disease.
Diagnosis begins with a history and physical exam. Several weeks after the pain begins, joint X-rays may show minor changes in the femoral head. Much later, the femoral head may collapse and flatten. If X-rays are normal at first and suspicion is high, the healthcare provider may order a bone scan or MRI.
About 50% of children, even with no treatment, will do well. The other half of affected children may have arthritis even as teenagers. The older the child at the time of onset, the worse the outcome. Prognosis is especially poor if the femoral head cannot fit securely in the acetabulum or hip socket.
Legge-Calve-Perthes disease is not contagious, and poses no risk to others.
The goal of treatment is to prevent arthritis. This is done by protecting the femoral head during the healing process, which takes many months. During this time, the femoral head must be secure within the socket of the hip joint. Some controversy surrounds treatment recommendations.
Initially, rest and restricted weight bearing can improve the comfort in the hip. This minimal treatment may be sufficient for a child under the age of 5 or 6. Similar treatment may be appropriate for an older child when there is no involvement of the weight-bearing part of the femoral head. Before any other treatment is started, motion of the hip is regained through gentle range-of-motion exercises.
When the hip is more involved in an older child, bracing of the joint may be recommended. An operation may be needed to reposition the bones within the joint. In rare cases when severe arthritis develops, a hip fusion operation may be required. This involves joining the bone of the joint together solidly. A hip joint replacement may become necessary in an older adult.
Surgery may cause bleeding, infection, or allergic reaction to anesthesia.
If full recovery occurs, a person can generally go back to normal activities. If symptoms continue, further treatment may be required.
Any new or worsening symptoms should be reported to the healthcare provider.