Legg-Calvé-Perthes disease (LCPD) is a condition that occurs due to a temporary loss of blood supply to the thighbone. This affects the shape of the bone, meaning it may not move easily in the hip socket.
Also known as Perthes disease or avascular necrosis of the hip, LCPD belongs to a group of conditions known as osteochondroses. This term refers to disorders that affect the bones in a growing skeleton. As such, LCPD typically affects children.
With LCPD, the upper end of the thigh bone, known as the femoral head, begins to break down due to an insufficient blood supply. This alters the shape of the bone, which may restrict movement of the affected hip. With early treatment, it is often possible to retain the spherical shape of the bone and prevent potential issues with the hips.
This article discusses LCPD, including its potential causes, symptoms, and treatment options.
The name of the condition
Some evidence suggests that the condition occurs in roughly 1 in 12,000 children. LCPD is 4–5 times more likely to occur in males than females and most often occurs between ages 6 and 9 years. It typically only affects one hip but can affect both.
The exact cause of LCPD remains unknown. However, research suggests it may be a multifactorial condition involving a combination of genetic and environmental factors.
Some evidence suggests that risk factors for LCP may include:
- low birth weight
- delayed skeletal maturity
- trauma
- adverse social and economic conditions
- exposure to tobacco smoke
- family history of LCPD
Additionally, some evidence suggests an association between LCPD and an alteration in the gene COL2A1. This gene plays a role in providing instructions for a type of collagen. As such, these variations may affect blood vessels within cartilage, which could lead to LCPD.
However, more research is necessary to determine the potential interactions that may result in LCPD.
LCPD progresses through four stages, each characterized by distinct changes in the affected hip joint. These phases are as follows:
- Necrosis: In the initial stage, blood supply is disrupted to the femoral head, leading to a lack of oxygen and nutrients. This results in the death of bone cells, causing the femoral head to become less round. This may lead to a stiff and painful hip joint that can last up to a year.
- Fragmentation: During this stage, the body gradually reabsorbs dead bone cells and replaces them with new, healthier ones. The femoral head starts to reform into a rounder shape. This process may cause pain and limited mobility and can last up to 3 years.
- Reossification: In this stage, new blood vessels begin to form, providing the necessary nutrients and oxygen to the fragmented bone. The femoral head continues to reform into a round shape with new bone. This phase may last for up to 3 years.
- Remodeling: The final stage involves the reshaping of the femoral head with regular bone cells to restore a more spherical appearance. This stage may take a few years to complete the healing process.
The symptoms of LCPD may vary among affected individuals. Common symptoms may include:
- hip or groin pain, which often worsens with activity and improves with rest
- a limp or altered walking pattern
- restricted range of motion in the hip joint
- muscle weakness in the affected leg
- in some cases, a noticeable difference in leg length
Early diagnosis is essential for the effective management of LCPD. Typically, a doctor will perform the following tests:
- Medical history and physical examination: The doctor will review the child’s medical history and inquire about symptoms. Additionally, they will perform a physical exam to assess hip mobility and range of motion.
- Imaging studies: X-rays can reveal characteristic changes in the shape and structure of the femoral head, which can help confirm the presence of LCPD. In some cases, a doctor may recommend an MRI scan to assess the extent of bone involvement or evaluate blood flow to the hip.
- Blood tests: Blood tests can help to rule out infections or other conditions.
The treatment approach for LCPD depends on the child’s age, stage of disease, and severity of symptoms. The goals of treatment include relieving pain, preserving hip joint function, and ensuring optimal bone and joint development. Common treatment options include:
Nonsurgical options
For very young children who show few changes to the femoral head, a doctor may initially recommend monitoring the condition with X-rays. They may also suggest anti-inflammatory medication to help reduce painful symptoms and limiting high impact activities, such as running, to help protect the femoral head.
A healthcare professional may also recommend physical therapy, as certain exercises can help maintain hip range of motion, strengthen surrounding muscles, and promote optimal joint function. In some cases, a brace or cast may help to hold the hip in a specific position, aiding in proper alignment and reducing pressure on the femoral head.
Surgical options
If nonsurgical treatments are unsuccessful, a healthcare professional may suggest surgery to re-establish the alignment of the femoral head in the hip socket. Surgery may be necessary if:
- the child is older than 8 years at the time of diagnosis
- damage is present in more than half of the femoral head
- nonsurgical efforts have not kept the hip in the correct position
The most common surgery for LCPD is an osteotomy. This surgical procedure involves cutting and repositioning the femoral head so it can better align in the hip socket. The surgeon will then secure the bone with a metal plate and screws.
Early detection, timely intervention, and consistent follow-up care are key to managing LCPD effectively and minimizing long-term complications.
Legg-Calvé-Perthes disease (LCPD) is a rare condition that affects the upper end of the thigh bone in children. While the exact cause is unknown, it occurs due to a temporary lack of blood supply to the femoral head. This results in damage to the upper end of the thigh bone, meaning it does not align properly in the hip.
As a result, this can cause pain, stiffness, and difficulty moving. A doctor can perform a physical exam and imaging tests to diagnose the condition. Treatment usually involves relieving pain, preserving hip joint function, and ensuring optimal bone and joint development. Sometimes surgery may be necessary.
In most cases, treatment is successful, and people can grow into adulthood without further hip issues. However, some people may develop hip problems in later life.