Legg-Calve-Perthes disease

Legg-Calve-Perthes Disease: A Rare Condition Affecting Children

Legg-Calve-Perthes disease, also known as Perthes disease, is a rare condition that affects the hip joint in children. It is characterized by a temporary loss of blood supply to the ball-shaped head of the thighbone (femoral head), leading to its collapse and inflammation.

Key Features:

• Affects children between the ages of 3 to 12 years old, with the highest rate of occurrence at 5 to 7 years [2]
• More common in boys than girls, with a male-to-female ratio ranging from 4:1 to 5:1 [2]
• Bilateral involvement occurs in 10% to 20% of cases [2]
• The condition is part of a group of disorders called osteochondroses, which involve the degeneration and regeneration of the growing end of a bone [3]

Symptoms and Diagnosis:

• Symptoms may include limping, pain in the hip, knee, thigh, and/or groin, muscle spasms, and limited or restricted movement of the affected hip [9]
• Diagnostic procedures may include X-rays, physical examination, and medical history [8]

Causes and Progression:

• The exact cause of Legg-Calve-Perthes disease is unknown, but it is believed to occur unexpectedly due to a disruption in blood flow to the femoral head [10]
• The condition progresses in stages over several years, with the affected bone undergoing degeneration and regeneration [3]

References:

[1] Context result 3 [2] Context result 2 [3] Context result 4 [8] Context result 8 [9] Context result 9 [10] Context result 10

Common Signs and Symptoms of Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease, a rare condition affecting the hip joint in children, can exhibit various signs and symptoms. These may include:

• Pain: Pain in the knee, thigh, or groin area is a common symptom, which can be relieved with rest and decreased activities.
• Limping: A limp or an abnormal gait pattern can be observed, especially after prolonged periods of activity or late in the day.
• Stiffness and reduced range of movement: The hip joint may become stiff, limiting its range of motion.
• Limited internal rotation and abduction: Physical examination may reveal decreased internal rotation and abduction of the hip.

Other Possible Symptoms

In some cases, additional symptoms may be present, including:

• Intense inflammation and irritation: The affected area may become intensely inflamed and irritated.
• Deformed femoral head: In severe cases, the femoral head can become deformed, leading to disability.

Age-Specific Considerations

It's essential to note that Legg-Calve-Perthes disease typically affects children between 3 and 10 years old. Males are more likely to develop the condition than females, with a male-to-female ratio ranging from 4:1 to 5:1.

These symptoms can be indicative of Legg-Calve-Perthes disease, but it's crucial to consult a doctor for an accurate diagnosis. A complete medical history, physical examination, and diagnostic procedures (such as X-rays) may be necessary to confirm the condition.

References:

• [2] - "Legg-Calve-Perthes disease is a rare condition that affects the hips of children aged 2 to 12."
• [3] - "The symptoms of Legg-Calvé-Perthes disease may resemble other conditions or medical problems of the hip."
• [5] - "The area becomes intensely inflamed and irritated, and your child may begin to show signs of the disease, such as a limp or different way of walking."
• [6] - "Legg-Calve-Perthes disease can exhibit various signs and symptoms, including pain, limping, stiffness, and reduced range of movement in the hip joint."
• [9] - "Symptoms of Perthes' disease include an occasional limp in the earlier stages, stiffness and reduced range of movement in the hip joint, and pain in the knee, thigh or groin area."
• [10] - "Legg-Calve-Perthes is a disease that happens when the hip joint does not get enough blood."

Diagnostic Tests for Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease, a rare condition affecting the hips of children aged 2 to 12, requires accurate diagnosis to initiate timely treatment. The diagnostic process involves a combination of medical history, physical examination, and various imaging tests.

• X-rays: Initial X-rays may not show changes in the hip, but it can take 1 to 2 months after symptoms begin for the changes related to Perthes disease to become clear on X-rays [1]. X-rays are often used as a first-line diagnostic tool.
• Magnetic Resonance Imaging (MRI): MRI is a more sensitive imaging test that provides detailed images of internal tissues, bones, and organs. It may be required for diagnosis of occult or unclear cases [15].
• Bone scan: A bone scan can help identify areas of abnormal bone metabolism, which may indicate Perthes disease.
• Complete blood count (CBC) with differential and measurement of the erythrocyte sedimentation rate (ESR): These tests may be used to rule out other conditions that could cause similar symptoms [7].
• Physical examination: A thorough physical exam by an orthopedic specialist is essential to identify signs such as a limp or loss of hip motion.

Diagnostic Teams and Specialists

A diagnostic team for Legg-Calve-Perthes disease may include:

• Orthopedics
• Genetics

These specialists work together to provide accurate diagnosis, treatment planning, and coordination of care [13].

Early Diagnosis and Treatment

Early diagnosis and treatment are crucial in allowing the head of the femur bone to remodel itself back into a round shape. This can prevent long-term damage and improve outcomes for children with Perthes disease [5].

Treatment Options for Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease, a rare condition affecting the hips of children aged 2 to 12, can be treated with various methods. While there is no cure for this condition, treatment aims to alleviate symptoms and prevent further damage.

Medications Used in Treatment

Several medications are used to treat Legg-Calve-Perthes disease, including:

• Ibuprofen: This medication is often prescribed to relieve pain and reduce inflammation in children with mild to moderately severe pain. [1]
• Bisphosphonates: These drugs may be recommended to help rebuild bone in children older than age six who have Perthes disease. They slow down the progression of the condition by preventing further bone loss. [3][6][8]

Other Treatment Options

In addition to medications, other non-surgical treatments for Legg-Calve-Perthes disease include:

• Activity restrictions: Limiting physical activity can help reduce pain and prevent further damage.
• Anti-inflammatory medication: Medications like ibuprofen can help reduce inflammation and alleviate symptoms.
• Bed rest and traction: Resting the affected area and using traction to hold the hip in place can help relieve pain and promote healing.

Surgical Treatment

In some cases, surgical treatment may be necessary to correct deformities or repair damaged bone. However, this is typically considered for children older than age six who have not responded to conservative treatments.

References:

[1] Apr 18, 2023 — Ibuprofen is usually the DOC for the treatment of mild to moderately severe pain if there are no contraindications. [3] Medications such as bisphosphonates may be recommended to help rebuild bone in children older than age six who have Perthes disease. [6] by ML Young · 2012 · Cited by 62 — The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity ... [8] by ML Young · 2012 · Cited by 62 — The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity.

Differential Diagnoses for Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease, a condition characterized by avascular necrosis of the femoral head in children, can be challenging to diagnose due to its similarity with other hip disorders. The following are some differential diagnoses that should be considered when evaluating patients with suspected LCPD:

• Hypothyroidism and Myxedema Coma: Although rare, hypothyroidism can cause avascular necrosis of the femoral head, which may mimic LCPD [6].
• Juvenile Idiopathic Arthritis (JIA): JIA is a common condition in children that can affect the hip joint, leading to symptoms similar to those seen in LCPD [6].
• Multiple Epiphyseal Dysplasia: This genetic disorder affects the growth plates of bones and can cause hip pain and deformity, which may be confused with LCPD [7].
• Pediatric Limp: A limp is a common presenting symptom of LCPD, but it can also be caused by other conditions such as hip dysplasia or osteomyelitis [6].

Other Conditions to Consider

In addition to the above differential diagnoses, the following conditions should also be considered when evaluating patients with suspected LCPD:

• Meyers Dysplasia: This is a rare genetic disorder that affects the growth plates of bones and can cause hip pain and deformity [7].
• Coxitis Fugax: A condition characterized by transient hip pain, which may mimic LCPD [11].

References

1. Al-Omran AK, Sadat-Ali M. Legg-Calve-Perthes disease in two generations of male family members: a case report. J Orthop Surg (Hong Kong) 2013;21(2):258–261.
2. Maranho DA, Nogueira-Barbosa MH, Zamarioli A, Volpon JB. MRI abnormalities of the acetabular labrum and articular cartilage are common in healed Legg-Calve-Perthes disease with residual deformities of the hip.

Note: The references provided are a selection of relevant studies from the search results and may not be an exhaustive list.