Summary about Disease
Legg-Calvé-Perthes Disease (LCPD) is a rare childhood condition that affects the hip. It occurs when the blood supply to the femoral head (the ball of the hip joint) is temporarily interrupted. Without adequate blood flow, the bone tissue dies (avascular necrosis). The body eventually revascularizes the femoral head, but during this process, the bone can weaken and fracture easily. The femoral head can then collapse, leading to deformity and potential long-term hip problems like arthritis.
Symptoms
Common symptoms of LCPD include:
Limping (often painless at first, but worsens with activity)
Pain in the hip, groin, thigh, or knee (pain may be intermittent)
Stiffness in the hip, limiting range of motion
Muscle weakness or wasting in the thigh (atrophy)
Shorter leg on the affected side (in later stages)
Decreased range of motion in the hip
Causes
The exact cause of LCPD is unknown. However, several risk factors have been identified:
Age: Most common in children between 4 and 10 years old.
Sex: More common in boys than girls.
Race: More common in Caucasians.
Genetics: While not directly inherited, there may be a genetic predisposition.
Blood clotting disorders: Some studies suggest a possible link.
Environmental factors: Exposure to tobacco smoke may increase the risk.
Medicine Used
There is no specific medication to cure LCPD. Treatment focuses on managing pain, maintaining hip range of motion, and protecting the femoral head from further damage while it heals. Medications may include:
Pain relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen. Stronger pain relievers may be prescribed in some cases.
Bisphosphonates: Some studies have explored the use of bisphosphonates to slow down bone breakdown, but their effectiveness is still under investigation.
Is Communicable
No, Legg-Calvé-Perthes Disease is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
Precautions focus on protecting the hip joint and preventing further damage:
Activity modification: Avoiding high-impact activities like running, jumping, and contact sports.
Weight-bearing restrictions: Depending on the severity of the condition, weight-bearing may be limited using crutches or a wheelchair.
Physical therapy: Following a prescribed exercise program to maintain hip range of motion and strength.
Orthotics/Bracing: Using braces or orthotics to position the hip joint correctly and reduce stress on the femoral head.
How long does an outbreak last?
LCPD is not an "outbreak." It's a chronic condition that develops over time. The entire process, from the initial interruption of blood supply to the complete healing and remodeling of the femoral head, can take 1 to 3 years, or even longer in some cases.
How is it diagnosed?
Diagnosis typically involves:
Physical examination: Assessing hip range of motion, pain, and gait.
X-rays: To visualize the femoral head and identify changes characteristic of LCPD.
MRI: To assess blood flow to the femoral head and identify early signs of the disease.
Bone scan: In some cases, a bone scan may be used to assess bone activity.
Timeline of Symptoms
The progression of LCPD can be divided into stages, with symptoms evolving over time:
Initial/Synovitis Stage: Mild pain, limping, stiffness; can last weeks to months.
Necrotic Stage: Bone cells die, the femoral head flattens; limping worsens, pain increases, range of motion decreases.
Fragmentation Stage: The body reabsorbs dead bone, leading to further flattening of the femoral head; pain and stiffness may persist.
Reossification Stage: New bone begins to grow; symptoms gradually improve.
Remodeling Stage: Bone reshapes and strengthens; long-term outcome depends on the shape of the healed femoral head.
Important Considerations
Early diagnosis and treatment are crucial to improve the long-term outcome.
Adherence to the treatment plan is essential for protecting the hip joint and promoting healing.
Regular follow-up appointments with the orthopedic surgeon are necessary to monitor progress.
Long-term complications such as arthritis and hip pain are possible, even with treatment.
Psychological support for the child and family is important, as LCPD can be a lengthy and challenging process.