Causes and risk factors
Legg-Calve-Perthes disease occurs when there is temporary reduction in blood supply to the head of the thigh bone due to which the bone dies and stops growing and there is slow healing. The exact cause behind temporary loss of blood supply is not known. Predisposing factors include trauma, sickle cell disease, steroid use, toxic synovitis, and congenital dislocation of the hip.
Clinical presentation
Symptoms include mild pain in the hip region; pain may be felt in thigh, groin, and knee region. Pain is worse on hip movement and is better by rest. Limping is observed. There is reduced range of movement of the hip joint.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. X-ray is usually sufficient to diagnose the condition. Several x-rays will be required to determine the progression of the disease and efficacy of treatment. MRI and/or bone scan may be required.
Treatment
Treatment depends upon the age of child. Children younger than 6 years of age usually are better with conservative management. Surgery is usually required for older children to reduce the risk of developing arthritis further in life. Conservative treatment includes anti-inflammatory drugs to reduce inflammation, analgesics for pain relief. Physical therapy is needed to increase the range of motion of hip joint. Use of crutches to avoid unnecessary weight on the hip joint can contribute further to the treatment. Traction along with bedrest in some cases will also help in managing the disease. Casts may be used for a period of 4-6 weeks in some cases. Surgery involves treating the deformed femoral head so that it can fit within the hip socket. It may include removal of contracture, removal of excess bone, and joint realignment.