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Legg-Calve-Perthes Disease

(LCPD; Osteonecrosis of the Hip; Avascular Necrosis; Ischemic Necrosis; Coxa Plana; Osteochondritis)
  • Definition

    Legg-Calve-Perthes disease (LCPD) is a rare hip disease. It affects children 2-12 years old. LCPD is a disorder of the top of the leg bone. The disorder interrupts blood flow to the hip. The loss of flow causes death of bone and impairs bone growth. Over time, it causes deformity as the bone breaks and reforms causing the child to limp. LCPD most often occurs in just one hip, with only about 10% of cases involving both sides.
    Hip Joint
    hip socket
    Damage and repairs to the femoral head causes a limp.
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  • Causes

    The cause of LCPD is unknown. Infection, trauma, and inflammatory processes are possible causes.
  • Risk Factors

    LCPD is more common in male and at ages 4-8 years. Othre factors that may increase your child’s chance of developing LCPD include:
    • Small or short for age
    • Delayed maturity
    • Athletic, active child
    • Race: Asian, White, Eskimo
    • Secondhand smoke exposure
    • Blood clotting abnormalities
  • Symptoms

    The primary symptom of LCPD is a limp when walking. This can occur in children 2-12 years old. It peaks in children 4-8 years old. Other symptoms may include:
    • Hip pain
    • Limping
    • Groin, thigh, or knee pain
    • Reduced range of motion in the hip
    • Shortening of the leg, or legs that are not the same length
    • Muscle weakness in the upper thigh
  • Diagnosis

    Your doctor will ask about your child’s symptoms and medical history. A physical exam will be done. During the exam, your child’s hip will be examined to see how far it can move. The doctor may refer your child to a specialist. An orthopedist focuses on bones and joints.
    Images may need to be taken of your child's bones. This can be done with:
  • Treatment

    Talk with your doctor about the best plan for you. Options include the following:
    Physical Therapy
    If your child’s symptoms are mild, your doctor may prescribe physical therapy. A therapist will work with your child to maintain range of motion. You may be taught certain exercises to do with your child at home.
    Medical Treatment
    Medical treatment is used to improve healing and prevent further injury to the hip.
    Medical treatment is used to improve healing and prevent further injury to the hip.
    • It may include using crutches, traction, a brace, or cast.
    • It is usually done before surgery is recommended for children less than 6 years old.
    Surgery
    In some cases, your child may need surgery.
    • The top of the thigh bone may be resurfaced with metal.
    • Bone removal may be done to reposition or reshape the hip bone.
    • Rarely the hip will be replaced.
  • Prevention

    There are no known ways to prevent this rare disease.
  • RESOURCES

    American Academy of Family Physicians http://familydoctor.org

    National Osteonecrosis Foundation http://www.nonf.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Adkins S, Figler R. Hip pain in athletes. Am Fam Physician. 2000 Apr 1;61(7):2109-2118. Available at: http://www.aafp.org/afp/20000401/2109.html. Accessed May 7, 2013.

    Kleigman, Behrman, et al, Eds. Nelson Textbook of Pediatrics.18th Edition. Saunders Elsevier, Philadelphia PA, 2007.

    Legg-Perthes disease. National Osteonecrosis Foundation website. Available at: http://www.nonf.org/perthesbrochure/perthes-brochure.htm. Accessed May 7, 2013.

    Leet AI, Skaggs DL. Evaluation of the acutely limping child. Am Fam Physician. 2000 Feb 15;61(4):1011-1018. Available at: http://www.aafp.org/afp/2000/0215/p1011.html. Accessed May 7, 2013.

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