LEGG-CALVÉ-PERTHES DISEASE

TYPES

Legg-Calvé-Perthes disease (LCPD) is a condition that affects the hip joint in children. It is a form of avascular necrosis, which means there is a temporary loss of blood supply to the head of the femur (thighbone) that leads to bone death and subsequent deformity. There are no specific types of Legg-Calvé-Perthes disease, but the condition can be classified based on the severity and the age at which it occurs. Here are some common classifications:

• Catterall Classification: This classification system categorizes LCPD into four stages based on X-ray findings. The stages range from initial fragmentation of the femoral head (stage I) to reossification and remodeling of the hip joint (stage IV). This classification helps in determining the prognosis and treatment options.
• Waldenström Classification: This classification system considers the age at which the disease occurs. It classifies LCPD into four groups: group A (under 6 years), group B (6-8 years), group C (8-10 years), and group D (over 10 years). The classification helps in predicting the outcome and determining the appropriate treatment approach.
• Herring Classification: This classification system focuses on the shape of the femoral head. It divides LCPD into six groups (A-F) based on the amount of femoral head involvement, shape, and joint congruity. The classification aids in assessing the severity of the disease and guiding treatment decisions.

SYMPTOMS

Legg-Calvé-Perthes disease (LCPD) is a condition that affects the hip joint in children. It occurs when there is a temporary interruption of blood flow to the femoral head (the rounded end of the thighbone) which leads to the death of bone cells and subsequent collapse of the bone. Here are some common symptoms associated with Legg-Calvé-Perthes disease:

• Hip or groin pain: Children with LCPD often experience pain in the hip or groin area. The pain may be mild at first and gradually worsen over time.
• Limping or favoring one leg: As the disease progresses, children may develop a limp or start to favor one leg while walking. This is often due to the pain and stiffness in the hip joint.
• Limited range of motion: The affected hip may have reduced mobility, making it difficult for the child to move the leg freely. Activities like running, jumping, or sitting for extended periods may be uncomfortable.
• Muscle atrophy: Over time, the muscles surrounding the hip joint may become weaker and smaller due to decreased usage and limited movement.
• Stiffness or decreased flexibility: The hip joint may feel stiff, and the child may have difficulty rotating the leg inward or outward.

DIAGNOSIS

Children who have Legg-Calvé-Perthes disease (LCPD) have hip joint problems. It happens when the head of the femur (the thigh bone) temporarily loses blood flow, which may result in bone death and potential deformity. The following measures are usually used to diagnose Legg-Calvé-Perthes disease:

1. Medical background: Your doctor will enquire about your child’s symptoms, such as limping, hip discomfort, or restricted range of motion. Additionally, they can ask about any prior injuries or a family history of hip issues.
2. Physical Examination: A thorough physical examination will be performed to assess the hip joint, including checking for hip range of motion, any signs of hip stiffness, and observing the child’s gait.
3. Imaging Tests: X-rays are the primary imaging tool used to diagnose Legg-Calvé-Perthes disease. X-rays can show changes in the shape and structure of the femoral head, which is characteristic of this condition. Additional imaging tests like an MRI or bone scan may be ordered to provide more detailed information about the extent of bone involvement and blood supply.

TREATMENT

The treatment of Legg-Calvé-Perthes disease (LCPD) aims to relieve symptoms, preserve hip function, and prevent long-term complications. The specific treatment options depend on various factors, including the child’s age, stage of the disease, and severity of symptoms. Here are some common approaches used in managing LCPD:

1. Observation: In some cases, especially during the early stages of the disease, observation and monitoring may be recommended. This involves regular check-ups and imaging tests to track the progression of the condition and determine if any further intervention is needed.
2. Activity Modification: Limiting some activities that place too much strain on the hip joint may aid with pain relief and stop additional harm. Your child’s doctor could give them some time off from sports and other high-impact activities.
3. Physical Therapy: A key component of the treatment for LCPD is physical therapy. It includes stretches and exercises that work to preserve joint mobility, strengthen the muscles around it, and increase hip range of motion. Your youngster will be led by a physical therapist via a special programme.
4. Bracing: In some cases, bracing may be recommended to help support the hip joint and promote proper alignment during the healing process. Braces, such as abduction braces or hip abduction orthoses, are typically worn for a specific duration and may be adjusted as the condition progresses.
5. Surgery: Surgery is reserved for cases where conservative treatments don’t provide sufficient relief or if the hip joint is severely affected. Surgical procedures can vary and may involve realigning the hip joint, removing damaged bone, or stimulating new bone growth. Your healthcare provider will discuss the surgical options and their potential benefits and risks.