A health condition that negatively affects the growth plate at the end of the femur, where it fits into the hip socket, is called Legg-Calvé-Perthes disease (also called Perthes disease). This condition causes the bone to break down and regenerate over a few years. Moreover, this process can change the shape of the bone and how it fits in the socket, but doctors can help prevent or fix this deformity.
Generally, this condition happens because the end of the bone loses its blood supply. Without oxygen-rich blood and nutrients, it begins to die and break down. When the blood flow returns, the bone begins to repair itself, but it will never get its original shape and size. Most of the time, this disorder affects children between the ages of 5 and 7, but it may also occur in children up to 12 years old. While bone breaks down from a blood loss within 1 year, the regrowth may take from 2 to 5 years. Furthermore, some children lose more bone tissue than others because it depends on several factors. For example, when the blood flow is interrupted, prolonged use of the bone while it is weakened, and other factors.
The goal of the treatment is to make sure the child’s bone regrows properly. Without treatment, this condition may cause complications later in life (such as arthritis).
Symptoms
Commonly, the symptoms of this rare disease appear over time. Check some early symptoms of Perthes disease below:
- A limp – This symptom causes your child to choose the leg that is not affected by this condition while walking. It often appears before the child notices pain.
- Hip pain – It often occurs when the bone starts to break down. Usually, pain worsens when the child moves the hip.
- Referred pain – Some children may feel pain in the thighs, pelvis, knees, or bellies.
- Leg cramps – This symptom occurs because of spasms in the muscles that are linked to the hip.
In more advanced stages, this condition may cause additional symptoms. Examples include:
- Limited range of motion – Children often have difficulty rotating their hips and are not able to open their thighs out.
- Muscle atrophy – In some cases, one side of their butt may look smaller compared to the part of the body where the disease does not affect the bone.
- Trendelenburg gait – It is also called an unusual walking pattern in which weak muscles of the hip make the child’s pelvic area tilt down. It often affects the way your child walks.
- Slightly different leg lengths – In children with Perthes disease, one leg may appear longer than the other.
Causes and Risk Factors
This condition happens when something stops or slows the blood supply to the head of the femur. Unfortunately, it is not always possible to determine what exactly causes it. Sometimes, blood flow can stop if a blood vessel is blocked or squeezed, an arterial disease, or a blood clot that reduces or blocks an artery that supplies the femur with oxygen-rich blood. Perthes disease can also happen due to swelling that compresses a blood vessel from the outside, sudden trauma, or repetitive strain injury. Furthermore, approximately 10% of diagnosed cases are genetic, which means an abnormal gene passes from the biological parents to the biological children during pregnancy. Researchers have identified that people with genetic Perthes disease have a mutation in the COL2A1 gene.
While anyone can develop this disease, there are some factors that could increase the risk even more. Check some of them below:
- Sex – Males are about 5 times more likely to have this condition than females.
- Blood-clotting disorders – Approximately 50% of children who develop Perthes disease have one of these disorders.
- Delayed skeletal growth
- Short stature
- Low birth weight
- HIV infection
- Abnormal teeth
- Environmental factors – Examples include prolonged exposure to secondhand smoke, lower-than-average socioeconomic status, and others.
What Happens if Legg-Calve-Perthes Disease is Left Untreated?
More than 50% of children with Perthes disease will experience complications, especially if the condition is left untreated. Check some complications below:
- Femoral head deformity – Frequently, in children with this disease, the hip joint becomes flattened or widened for the rest of their life because it fits improperly in the socket.
- Arthritis – This is a serious complication of Perthes disease that often appears later in life.
- Hip dislocation or subluxation – In more advanced stages, the head of the femur bone may partially dislocate from the socket.
- Muscle atrophy – The muscles around the thigh and hip may weaken from decreased use.
- Labral tears – When the joint does not move properly, it may lead to injuries in the hip cartilage.
This document does not contain a complete list of Perthes disease complications. However, doctors may help reduce the risk or even prevent some of them. Unfortunately, there is no sure way to prevent this condition because doctors do not fully understand what exactly causes it. The only way to prevent serious complications is early detection and proper treatment.
Diagnosis
Most of the time, the diagnosis of Perthes disease starts with a physical examination in which doctors will check for irregularities linked to this disorder. However, to confirm the diagnosis and determine the stage of the disease, physicians will perform some of the following tests. Examples include:
- X-rays
- CT (computed tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
Treatment
Healthcare professionals usually prescribe different treatment options for people who develop Legg-Calve-Perthes disease because they depend on several factors. For example, the severity and stage of the condition, age, gender, overall health, and preferences. Mostly, children with this condition tend to improve with conservative options because their bones naturally grow and develop faster. Check some options often recommended by doctors below:
- Restricted physical activity – Children who develop this condition should stop or limit walking for a short period. Some of them may also need crutches or another assistive device to walk.
- NSAIDs (nonsteroidal anti-inflammatory drugs) – This group of medications is often recommended by doctors to relieve pain caused by Perthes disease.
- Physical therapy – It often helps your child recover faster.
- Traction – Your child may need an orthopedic traction device that applies gentle and increasing force to stretch the hip.
- A cast or brace – These devices are often required during the recovery phase.
- Surgery – In more severe cases, doctors recommend this treatment to reshape the bone. Sometimes, during this procedure, surgeons may also replace the affected joint to extend the hip socket.
Frequently Asked Questions
What is the long-term prognosis for Perthes disease?
Early detection and proper treatment usually help prevent serious complications and improve your child’s quality of life.
What are the symptoms of Perthes disease in children?
The most common symptoms of this disorder are prolonged limp, hip stiffness, and aching pain in the groin, thigh, or knee. Commonly, pain can become more severe with physical activity.
Can Legg-Calve-Perthes Disease return?
While this condition is a frequent pathology, it recurs extremely rarely.
What age group is most commonly affected by Legg-Calve-Perthes disease?
Legg-Calve-Perthes disease most commonly affects children between 4 and 10 years of age, with the highest incidence occurring between ages 5 and 7. Although it is more common in boys, girls can develop the condition as well.
Can Perthes disease affect both hips?
In most cases, Perthes disease affects only one hip. However, approximately 10% to 15% of children may develop the condition in both hips, although it usually does not occur at the same time.
How long does recovery from Perthes disease take?
Recovery varies depending on the child’s age, the severity of the disease, and their response to treatment. Most of the time, the healing and remodeling process can take between 2 and 5 years before the bone fully stabilizes.
Can children with Perthes disease participate in sports?
Children with Perthes disease may need to temporarily avoid high-impact activities such as running, jumping, and contact sports. Once healing progresses and the physician approves, many children can gradually return to physical activities.
Does Perthes disease always require surgery?
No. Many children respond well to conservative treatments such as activity modification, physical therapy, braces, and pain management. Surgery is generally reserved for more severe cases or when the hip joint is at risk of developing severe deformity.
Is Perthes disease hereditary?
Most cases occur without a clear inherited cause. However, a small percentage of diagnosed cases are linked to genetic mutations, particularly in the COL2A1 gene. Having a family history of the condition may slightly increase the risk.
Can adults develop Legg-Calve-Perthes disease?
Perthes disease is considered a childhood disorder and does not usually develop in adults. However, adults who had Perthes disease as children may experience long-term complications, such as hip stiffness, reduced mobility, or early-onset osteoarthritis. Ask your healthcare provider if you have additional questions.
