Legg-Calvé-Perthes Disease is a condition of the hip. In a normal hip, the ball of the thighbone (femur) sits in the socket of the hipbone. In LCPD, the blood supply stops making its way to the bone in this hip joint. Because of this, the bone begins to break down.

This condition is sometimes called avascular necrosis (AVN). Avascular necrosis means loss of blood flow to the bone. When AVN happens in the ball of the hip in a young child, it is called Legg-Calvé-Perthes (LCP).

LCPD is temporary. The active phase will complete its course in about two to three years. Most kids with this condition can eventually return to their regular activity level after being treated. 

Incidence

A child with LCPD is often very active compared to other children. The start of the disease occurs when the child is between 3 and 10 years old. It is most common in children ages 5 to 7 years old. Males are three to five times more likely than females to develop the disease.

Signs and Symptoms

Symptoms can include:

• Limping, which may get worse late in the day or after activities. This gets better with rest.
• Leaning side to side when walking.
• Pain in the groin, front of the thigh, or knee that gets worse with physical activity. The pain often is worse late in the day. Some children may have pain at night.
• Muscle spasms that limit the movement in the hip.

Diagnosis

X-rays are used to confirm diagnosis. A bone scan or MRI may also be used.

Stages of Legg-Calvé Perthes Disease

1. Initial Stage (lasts about six months)
   • The child’s symptoms may get better and then get worse.
2. Fragmentation Stage (lasts about eight months)
   • This is the stage where the head of the femur breaks down. 
   • The child’s pain and limp become more obvious. 
   • There is more loss of motion in the hip. 
   • The degree of symptoms may be different from child to child. 
3. Healing Period (lasts about four years)
   • New bone grows in the head of the femur.
   • The pain and limp usually start to improve. 
   • Some limitation of hip motion continues. 
   • The child will slowly return to normal activities. 
4. Residual Stage (until growth is done)
   • The shape of the head of the femur may continue to change until growth stops.

Treatment

The goal of treatment is to slow the need for a total hip replacement until a later age. Successful treatment will allow the ball of the thighbone to heal. This will help it return to a round shape.

Treatments include:

• Observation. Your doctor may want to monitor the joint. They may use regular X-rays to see how the bone is growing.
• Limiting activity. Your doctor may recommend avoiding activities like running and jumping. This can help limit pain in the joint. Using crutches or a walker can also help.
• Physical therapy. This can help stretch muscles that are tight, strengthen muscles around the hip and work on walking to reduce limping.
• Surgery. This is a two-stage procedure. These procedures are done six weeks apart.
  • The first surgery will allow your child to regain motion of the hip. This is called a medial soft tissue release. A Petrie cast is applied.
  • The second procedure gives better coverage of the ball of the hip. This is very important. It helps better distribute the weight-bearing area of the hip. It decreases the chance of future arthritis. The surgeon will cut the bones of the pelvis and rearrange the ball of the hip into the pelvis so there is more coverage. Sometimes a cut on the femur, called a femoral osteotomy, also happens.

Long-Term Outlook

For about two years, the child will be restricted from many activities including running and jumping. Even after LCPD / AVN has resolved, it is best if your child avoids contact and collision activities. They should also avoid running and cutting sports. Children with this condition do well with low-impact activities like biking and swimming.

If problems continue into adulthood, sometimes we will recommend a total hip replacement.