Letting Go Of Legg-Calve-Perthes Disease
Your child is in pain. He walks with a limp. He has a spasm in the leg and a limited range of motion. He could have Legg-Calve-Perthes disease.
Legg-Calve-Perthes disease describes when the blood supply to the top of the leg bone (or femoral head) is restricted, the bone disintegrates and the femoral head becomes flattened. As a result, it doesn’t fit properly in the hip socket. This can make it painful to walk. Eventually the the hip and thigh will disconnected.
As children develop, alternate sources of blood occur naturally which supply the femoral head. The bone rejuvenates but can be deformed and can result in limited range of motion and osteoarthritis of the hip if untreated.
The disease mainly affects Caucasian boys ages 3 to 12. Legg-Calve-Perthes affects Asians and Eskimo children as well. Its cause is unknown.
The condition is characterized by a loss of circulation to the ball of the hip in a growing child, resulting in the death of bone cells. There is a period of regrowth lasting from 18 to 24 months, but the new bone is soft and can fracture and regrow into a non-spherical shape, causing pain and stiffness.
Legg-Calve-Perthes disease affects less than 1 percent of the general population and is therefore very rare. Some studies indicate that children with parents who have the disease are more likely to get it.
According to the Cleveland Clinic, the disease tends to affect children who are very active or athletic. Children who are smaller than average for their age.
Exposure to secondhand smoke also plays a factor in increasing the risk of Legg-Calves-Perthes disease.
Technically, the ball of the femur dies because the blood supply to it is temporarily cut off. Some research shows that genetics may play a role, but more study is needed. The lack of a steady blood supply to the femur causes a sequence of events. First, bone cells in the head of the femur die. Then weakness in this area causes the head of the femur to eventually collapse (which usually occurs over a two-year period) and lose its roundness. This is called “fragmentation.”
The damaged bone tissue is then absorbed by the body. When the blood supply returns, new bone tissue begins to grow and take the shape of the new femur head. This stage can last a few years. Finally, the bone heals in its final shape, though this final shape is not always a perfect, round head.
How well the head of the femur heals into a rounded shape depends on the extent of the bone collapse and how old your child is at the time that the disease process started. Bone tends to reshape better in younger children and improves as the child grows.
Some symptoms of the disease include:
§ Pain in the hip area, or in the groin, thigh, even the knee.
§ Irritation and inflammation in the hip area that could result in muscle spasms.
§ Pain with activity; relief when at rest.
§ Stiffness or decreased motion in the hip joint.
Pain may occur on and off for months. Pain may occur without an injury associated with it. Some children don’t feel any pain at all and the condition may be discovered by X-ray due to a fall or other injury. X-rays are used to diagnose Legg-Calve-Perthes disease. Your provider may order a MRI to check disease progression.
Your provider may order additional tests to check disease progress. For instance, your physician may measure your child’s thigh to check for muscle atrophy or loss of muscle tissue. Your healthcare provider may have your child do certain activities to check range of motion.
Treatment includes a brace which is worn constantly except for physical therapy and recommended water exercises. The brace eliminates weight bearing on the hip and the femoral head and also positions the legs so that the blood supply to the area is restored. The child is encouraged to walk with the brace. Over one or two years the femoral head resumes its proper shape and the brace is removed.
Surgery to correct the inefficient blood supply is another option. No brace is worn following surgery. But your child may need to be placed in a cast for six to eight weeks after surgery. Physical therapy is required after surgery to help with the healing process. Your provider may perform more X-rays to determine whether or not your child is healing.
Legg-Calve-Perthes disease is a highly treatable condition. Watch your child closely after an injury, starting with any change in walk or whether or not your child develops a limp. Don’t hesitate to contact your healthcare provider.
