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Legg-Calve-Perthes disease

Legg-Calve-Perthes (LEG-kahl-VAY-PER-tuz) disease is a childhood condition that occurs when blood supply to the ball part (femoral head) of the hip joint is temporarily interrupted and the bone begins to die.

This weakened bone gradually breaks apart and can lose its round shape. The body eventually restores blood supply to the ball, and the ball heals. But if the ball is no longer round after it heals, it can cause pain and stiffness. The complete process of bone death, fracture and renewal can take several years.

To keep the ball part of the joint as round as possible, doctors use a variety of treatments that keep it snug in the socket portion of the joint. The socket acts as a mold for the fragmented femoral head as it heals.

Symptoms of Perthes disease include:

Perthes disease usually involves just one hip. Both hips can be affected, but they usually are affected at different times.

When to see a doctor

Make an appointment with your healthcare professional if your child begins limping or complains of hip, groin or knee pain. If your child has a fever or can’t bear weight on the leg, seek emergency medical care.

Perthes disease occurs when too little blood reaches the ball portion of the hip joint for a short time. Without enough blood, this bone becomes weak and collapses. The cause of the reduced blood flow is unknown.

Risk factors for Perthes disease include:

Children who have had Perthes disease are at higher risk of developing hip arthritis in adulthood — especially if the hip joint has poor healing. If the ball-and-socket joint doesn’t fit together well after healing, the joint can wear out early.

In general, children who are diagnosed with Perthes disease after age 6 are more likely to develop hip conditions later in life. The younger the child is at the time of diagnosis, the better the chances for the hip joint to heal in a typical, round shape.

During the physical exam, your healthcare professional might move your child’s legs into various positions to check range of motion and see whether any of the positions cause pain.

Imaging tests

These types of tests, which are vital to the diagnosis of Perthes disease, might include:

In Perthes disease, the complete healing process can take several years. The types of treatment recommended depend on the:

As Perthes disease gets worse, the ball part of the joint, called the femoral head, weakens and breaks apart. During healing, the socket part of the joint can serve as a mold. This can help the weakened femoral head keep its round shape.

For this molding to work, the femoral head must sit snugly within the socket. Sometimes a child wears a special type of leg cast that spreads the legs widely apart for 4 to 6 weeks to keep the bone in the right position.

Some children need surgery to help keep the ball of the joint snug within the socket. This procedure might involve making wedge-shaped cuts in the thighbone or pelvis to align the joint again.

Surgery generally isn’t needed for children younger than 6. In this age group, the hip socket is naturally more moldable, so the ball and socket usually continue to fit together well without surgery.

Other treatments

Some children, especially very young ones, might need only conservative treatments or observation. Conservative treatments can include:

You’ll probably first talk with your child’s primary care team about your concerns. After an initial evaluation, your child might be referred to a doctor who specializes in bone conditions in children, called a pediatric orthopedic surgeon.

What you can do

Before your appointment, you may want to write a list of answers to the following questions:

What to expect from your doctor

Your healthcare team might ask some of the following questions:

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