Summary about Disease
Legg-Calvé-Perthes disease (often shortened to Perthes disease) is a rare childhood condition that affects the hip. It occurs when the blood supply to the femoral head (the ball-shaped top of the thighbone that fits into the hip socket) is temporarily interrupted. Without sufficient blood flow, the bone cells die, leading to osteonecrosis (bone death). The body then reabsorbs the dead bone, which can weaken the femoral head. Over time, with proper treatment, the blood supply usually returns, and the bone rebuilds itself. The femoral head can become deformed during this healing process, which can lead to pain, stiffness, and arthritis later in life.
Symptoms
The symptoms of Perthes disease can vary from child to child and can develop gradually. Common symptoms include:
Limping (often painless at first, but becomes more noticeable with activity)
Pain in the hip, groin, thigh, or knee (pain may worsen with activity and improve with rest)
Stiffness or limited range of motion in the hip
Shorter leg on the affected side (due to slowed growth of the femoral head)
Muscle weakness or wasting in the thigh (atrophy)
Irritability or crying in young children due to pain
Causes
The exact cause of Perthes disease is unknown. However, it is believed to be multifactorial, meaning several factors may contribute to its development. Possible contributing factors include:
Temporary interruption of blood supply: This is the primary event leading to bone death. What triggers this interruption is unclear.
Genetic predisposition: While not directly inherited, some studies suggest a genetic component might make some children more susceptible.
Blood clotting abnormalities: Some research indicates a possible link between Perthes and blood clotting disorders.
Environmental factors: More research is needed to see if environmental factors play a role.
Medicine Used
There is no specific medication to cure Perthes disease. Treatment focuses on managing symptoms, protecting the hip joint, and promoting healing. Medications may include:
Pain relievers: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage pain and inflammation.
Anti-inflammatory medications: In some cases, stronger anti-inflammatory medications (NSAIDs) may be prescribed by a doctor.
Bisphosphonates: Some studies suggest bisphosphonates may help improve bone density and reduce bone breakdown, but their use in Perthes disease is still being researched.
Muscle relaxants: If muscle spasms are present, muscle relaxants might be prescribed. NOTE: Medicines used and their dosages will be prescribed by the medical practitioner only after diagnosis.
Is Communicable
No, Perthes disease is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
The primary precautions for a child with Perthes disease involve protecting the hip joint to prevent further damage and promote healing. These include:
Limiting weight-bearing activities: Activities that put stress on the hip, such as running, jumping, and high-impact sports, should be avoided or modified.
Using assistive devices: Crutches or a walker may be necessary to reduce weight-bearing on the affected hip.
Maintaining a healthy weight: Excess weight can put additional stress on the hip joint.
Following physical therapy recommendations: Physical therapy exercises help strengthen the muscles around the hip and improve range of motion.
Adhering to bracing or casting protocols: If a brace or cast is prescribed, it is crucial to wear it as directed by the doctor.
How long does an outbreak last?
Perthes disease is not an "outbreak," but a long-term condition. The entire process, from the initial interruption of blood supply to the complete healing and remodeling of the femoral head, can take several years – typically between 1 to 3 years, and in some cases, longer. The time frame varies depending on the child's age, the severity of the disease, and the effectiveness of treatment.
How is it diagnosed?
Perthes disease is usually diagnosed through a combination of:
Physical examination: The doctor will assess the child's range of motion, gait (walking pattern), and pain levels.
X-rays: X-rays are the primary imaging tool used to diagnose Perthes disease. They can reveal changes in the shape and density of the femoral head.
MRI (Magnetic Resonance Imaging): MRI provides more detailed images of the hip joint and can detect early changes in the blood supply to the femoral head, even before they are visible on X-rays.
Bone scan: A bone scan can help assess the blood flow to the bone.
Timeline of Symptoms
The timeline of symptoms in Perthes disease typically progresses through several stages:
Initial Stage (Early Symptoms): Mild hip or groin pain, a slight limp, and reduced range of motion. These symptoms may be intermittent and easily dismissed.
Fragmentation Stage: The femoral head begins to break down, and symptoms become more noticeable. Pain may worsen, limping becomes more pronounced, and stiffness increases.
Reossification Stage: New bone starts to form, and the femoral head begins to rebuild. Pain may decrease somewhat, but stiffness and limited range of motion persist.
Remodeling Stage: The new bone continues to remodel and strengthen. The shape of the femoral head may improve, but some deformity may remain. Symptoms gradually improve, but some residual stiffness or pain may persist.
Important Considerations
Early diagnosis and treatment are crucial: The earlier Perthes disease is diagnosed and treated, the better the chance of a favorable outcome.
Adherence to treatment is essential: Following the doctor's recommendations regarding weight-bearing restrictions, bracing, physical therapy, and medications is vital for successful healing.
Regular follow-up appointments are necessary: The child will need regular checkups with an orthopedic surgeon to monitor the progress of healing and adjust the treatment plan as needed.
Long-term monitoring is important: Even after the femoral head has healed, long-term monitoring is necessary to watch for any signs of arthritis or other complications.
Each child's experience is unique: The course of Perthes disease can vary significantly from child to child. Parents should work closely with their child's healthcare team to develop an individualized treatment plan.
Emotional support is important: Dealing with Perthes disease can be challenging for both the child and their family. Providing emotional support and encouragement is essential.
Activity Modifications: It may be important to modify activity. In some situations, high impact and higher-risk activities should be avoided long-term.